Archived: Earlfield Lodge

Earlfield Lodge is a residential care home providing accommodation and personal care to older people, some of whom are living with dementia. The service can support up to 72 people. There were 52 people living at the service at the time of the inspection.

The service provides period accommodation in several adjoining premises. The service is over five floors. There are four areas to the service Bluebell, Lilly, Poppy and Buttercup. There is access to a garden and patio area.

At the time of the inspection the service had an additional seven beds registered in the adjacent property. There was no one living in this building and no service was operating from this site.

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

People received unsafe care as the service had not made improvements or met legal requirements. In areas such as risk management, medicines, recruitment and staffing. Issues previously identified and highlighted had not always been addressed. The systems to monitor and oversee the safety and quality of the service were not effective. This put people at risk as improvements were not made in areas required.

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 Inadequate (published 29 October 2019). There were five breaches of regulations identified and a recommendation made. Previous to this, the service had been rated requires improvement for the last four consecutive comprehensive inspections (published 12 August 2015, 17 November 2016, 12 January 2018, 15 September 2018).

At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 5, 6 and 12 September 2019. Breaches of legal requirements were found in regulation 12, 13, 17, 18 and 19 and a recommendation was made in relation to end of life care planning.

We undertook this focused inspection to check their action plan had been followed, improvements were in progress and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remained the same and is inadequate. 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

We have identified four continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in regulation 12; safe care and treatment, regulation 18; staffing, regulation 19; fit and proper persons employed and regulation 17; good governance.

At the last inspection a recommendation in the Responsive domain was made in end of life care planning. This domain was not reviewed during this focused inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow Up

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’.

Earlfield Lodge is a residential care home providing accommodation and personal care to older people, some of whom are living with dementia. The service can support up to 72 people. There were 54 people living at the service at the time of the inspection.

The service provides period accommodation in several adjoining premises. The service is over five floors. There are four areas to the service Bluebell, Lilly, Poppy and Buttercup. There is access to a garden and patio area.

At the time of the inspection the service had seven beds registered in the adjacent property. There was no one living in this building and no service was operating from this site.

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

People received a poor quality of care as the service had not made or sustained improvements. Issues previously identified and highlighted had not been addressed. The provider lacked oversight of the service which put people at risk as improvements were not made in areas required.

Whilst people told us they were happy at Earlfield Lodge the failure to meet regulations and the organisational issues put people at risk of unsafe care and support. This was due to medicines not being managed safely, staff being recruited without completing safe recruitment processes and safeguarding procedures not always being followed. Staff continued to not receive regular training in key areas. This meant they may not be aware of systems and processes to follow, which put people at risk.

Audits were completed to monitor the quality of the service. However, these were not fully effective as they did not lead to improvements in all areas required. Staff roles and responsibilities were not defined and led to a lack of accountability. There was not an effective staff culture which supported the service to develop and improve.

People were supported by staff who were kind, caring and knew them well. Care plans gave information about people’s backgrounds and histories. People were enjoying the activities now provided. People felt comfortable to raise concerns and complaints which were investigated.

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 15 September 2018). There were two breaches of regulations and a recommendation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. One of these regulations and the recommendation had now been met. However, we found a continued breach in Regulation 18; Staffing and identified breaches in other regulations at this inspection. This service had been rated requires improvement for the last four consecutive comprehensive inspections (published 12 August 2015, 17 November 2016, 12 January 2018, 15 September 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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

We have identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, fit and proper persons employed, safeguarding people, good governance and a continued breach in staffing at this inspection. We also made a recommendation in end of life care planning.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow Up

We will meet with the provider following this report being published to discuss the findings. We will work with the local authority to monitor progress.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Following this inspection, we issued a warning notice in regard to Regulation 12, safe care and treatment. People who used the service were at risk due to the unsafe management and administration of medicines. We followed this warning notice up at a focused inspection in February 2018. We found that the service had met the warning notice but further improvements were still required in medicines administration.

The breaches previously identified were followed up as part of our inspection. You can read the report from our last inspections, by selecting the 'All reports' link for Earlfield Lodge, on our website at www.cqc.org.uk. The service remains rated as requires improvement.

Earlfield Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Earlfield Lodge can provide care and support to 72 older people, some of whom are living with dementia. At the time of our inspection there were 58 people living at the service.

The service provides accommodation in several adjoining premises. The service is over five floors. There are four areas to the service Bluebell, Lilly, Poppy and Buttercup. There is access to a garden and patio area.

Two registered managers were in post at the time 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.

Improvements had been made at the service. The previous breaches in regulation identified, except one, had now been met. An action plan monitored the progress of improvements required across the service.

The service had not displayed its previous ratings in the service as required. Training for staff was not up to date. However, future training had been scheduled for some of the areas required by staff. Feedback around the activity provision at the service was poor. There was no one identified as responsible for activity provision within the service.

Changes had been made in the management structure. However, further clarity on staff roles, responsibilities and accountability were needed to ensure the service ran effectively.

Feedback demonstrated that improvements were required in managing staff absence. Improvements had been made in medicines administration. However further areas were identified. Infection control policies were in place. Staff were knowledgeable of these policies. However, areas of infection control were identified for improvement.

The recording of incident and accident had improved. Quality audit systems had been reviewed and changed to monitor the service more effectively. Recruitment procedures had been revised so they were in line with legislation. Systems were in place to ensure these were followed. Enhancements had been made to the environment to ensure it was safe and pleasant. Systems had been improved to monitor the premises, equipment and fire safety assessments.

Notifications had been submitted as required. Systems had been revised so that staff received regular support through supervision. The monitoring of support around food and fluid had improved which had resulted in positive outcomes for people.

The service had made improvements to ensure it was compliant with the Deprivation of Liberty Safeguards (DoLS). Care plans had been completed in full. These were person centred in detail. Induction procedures had been strengthened. These incorporated changes made in systems and processes.

Staff responded promptly to people’s support needs. Staff were kind and caring and had positive relationships with people. People commented the atmosphere was friendly and homely.

Visitors were welcomed at the service. People and relatives were comfortable in raising any concerns or complaints. Feedback received was that staff and management were approachable. Opinions and feedback from people, relatives and staff was sough through meetings and surveys.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also made a recommendation about activity provision. You can see what action we told the provider to take at the back of this report.

We undertook a focused inspection on 22 January 2018 to check the provider was meeting the legal requirements in regards to one of the regulations they had breached and had complied with the Warning Notice. This focused inspection looked at the breach of regulation 12. This report only covers our findings in relation to this area. You can read the report from our last comprehensive by selecting the, 'All reports' link for ‘Earlfield Lodge’ on our website at www.cqc.org.uk

Earlfield Lodge provides accommodation and personal care for up to 65 older people, some of whom are living with dementia. At the time of our inspection the service was providing accommodation and personal care to 56 people.

There was a registered manager in post. 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.

At this inspection, we found the provider had taken action to comply with the warning notice. We made a recommendation about the recording of topical medicines as further improvements were required.

Medication Administration Records (MAR) were being completed consistently. A daily system was in place to identify and take action around any gaps in recording. Photographs of people, descriptions of how people preferred to take their medicines and protocols for as required medicines had been included in people’s medicines records. Records were kept on why as required medicines had been administered.

Self-medication risk assessments had been completed where appropriate. The medicines policy had been reviewed and amended.

Earlfield Lodge provides accommodation and personal care for up to 65 older people, some of whom are living with dementia. At the time of our inspection the service was providing accommodation and personal care to 59 people.

A registered manager was in post at the time 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.

The service was not well-led. Quality audits were in place but did not monitor and review all areas of the service. Therefore the extensive failure to meet the regulations found at this inspection had not been identified by the registered person. The current management structure was ineffective as all quality oversight was delegated to senior staff. Notifications had not been sent to the Commission as legally required to inform of significant events such as Deprivation of Liberty Safeguards authorisations and events that stop the service.

The service was not safe. Medicines administration was not being managed safely and areas previously highlighted to the provider had not been addressed. Environmental risk assessments were not in place and regular checks of all areas were not conducted to keep people safe. Recruitment procedures were not followed in line with the provider’s policy. This meant effective checks were not completed before new staff began their employment.

People were not always being deprived of their liberty in accordance with legislation and guidance. Food and fluid records were not being consistently maintained. Staff were not supported through regular supervision and training. This meant that staff development needs were not always being identified and staff may not have had sufficient training in particular areas of their role.

Care plans were not always person centred as people’s background and histories were not consistently completed. Mixed feedback was received about the provision of activities at the service. The service was fully staffed. However, observations were made that staff were not always responsive to people’s needs in a timely manner.

Staff completed an induction when they started at the service, which orientated them to systems, processes and people. People had access to healthcare and the provider had good relationships with other health professionals. People and relatives knew how to raise concerns and complaints and felt comfortable to do so. Complaints were investigated and responded to. Staff were aware how the Mental Capacity Act (MCA) 2005 applied to their role.

People received care and support from staff that were kind and caring. Family and friends were welcomed at the service. People’s independence was encouraged and promoted. People, relatives and staff’s views were sought through different methods, such as meetings and questionnaires. Effective communication systems were in place.

We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of this report.

Earfield Lodge is a care home providing accommodation for up to 65 older people some of whom are living with dementia but do not having nursing needs. During our inspection there were 59 people living at the home. The home is a large detached house situated in a residential area of Weston Super Mare and is set out into four separate units called Buttercup, Poppy, Lilly and Bluebell Cottage. Poppy and Lilly units provide residential care to older people, Lily and Bluebell Cottage provide care to older people who are living with dementia.

A registered manager was in post at the time of the inspection visit. 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 were not receiving their medicines safely. We found other concerns in relation to the management of people's medicines. Improvements were needed in the management of people's medicines. This is a breach of Regulation 12(1) (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the end of this report.

People told us they felt safe living at the service. The environment was kept clean and free from hazards. Equipment and hazardous substances were safely stored and used appropriately.

Staff received training in relation to keeping people safe and they were confident about the action they needed to take if they had any concerns about people's safety, including safeguarding concerns. Care plans included information about people's abilities to make decisions and where required applications had been made to the local authority for Deprivation of Liberty Safeguards (DoLS) authorisations in respect of people. Staff obtained people's consent prior to delivering care and support and they respected people's decisions.

People received the care and support they needed with their healthcare needs. They attended appointments as required with their GP and other health care professionals involved in their care. Prompt referrals were made for people to other professionals when concerns about their health and wellbeing were noted.

Risk assessments had been carried out when planning people's care and appropriate risk management plans were put in place instructing staff on how to provide people with safe care and support.

People's dietary needs were understood and met. People told us they liked the food they were offered and that they were given plenty to eat and drink. Mealtimes were a positive experience for people and they had a choice of food and drink and where they ate their meals.

Staff received training and support which they needed to meet people's needs. Training was provided to staff on an ongoing basis and their competency was checked to make sure they understood and benefited from the training undertaken.

Regular staff meetings and one to one supervision sessions enabled staff to explore their training needs and discuss any additional support they needed to carry out their roles effectively.

People's privacy, dignity and confidentiality were respected.

Staff had a good understanding of people's needs, including their preferred gender of carer, routines, wishes, likes and dislikes.

Staff approached people in a kind, caring and patient manner. Information about the service including planned changes to the environment and up and coming events was shared with people and their family members in a timely way.

People, family members, staff and external health and social care professionals were complementary about the way the service was managed.

People, their relatives and staff described the management team as approachable and supportive and they had confidence in them. They said there was an open door policy operated at the service, which enabled them to speak openly, and in confidence with the management team.

Is the service safe?

People told us that they felt safe. Safeguarding and whistleblowing procedures were robust and staff understood how to safeguard the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the provider to maintain safe care. The provider had robust policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. At the time of inspection, two people were subject to Deprivation of Liberty Safeguards. These had been put in place in a manner consistent with the law.

Is the service effective?

People's health and care needs were assessed with them and they or their representatives were involved in the compilation of their care plans. People said that they had been involved in the process and that care plans reflected their current needs.

Is the service caring?

We spoke with people who live at the home. We asked them for their experience about the staff that supported them. Feedback from people was positive, for example one person said, "I don't have anything negative to say. I enjoy living here". Another person told us, "The staff are lovely. It's a home from home".

People who live at the home and their families were asked to complete a satisfaction survey by the provider. These were used to help improve the service in the future.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

The home worked well with other agencies and services to make sure people received care in a coherent way.

People knew how to make a complaint if they were unhappy. Complaints were dealt with in a timely and satisfactory manner.

People engaged in a range of activities both in the home and in the wider community.

Is the service well-led?

The service operated a quality assurance system which identified and addressed shortcomings. As a result, a good quality of the service was maintained.

The staff we spoke with were clear about their roles and responsibilities. They had a good understanding of the needs of the people they were caring for and were properly trained and supported to carry out their duties.

At the last inspection we found that people who had dementia were not always treated with respect and dignity. We found that people who had dementia were served meals on plastic plates and given drinks in plastic picnic beakers. This practice was not person specific and there was no rationale in care plans for it.

At this inspection we spent time observing lunch time in the part of the home which cared for people with dementia. We saw that people were shown two different meals to choose from and were served vegetables according to their wishes. Everyone was served their meal on a china plate and provided with glasses to drink from. People were able to eat in a relaxed and unhurried atmosphere. This meant that people with dementia were treated with the same respect as other people who lived in the home.

We observed that staff spoke with people in a friendly and polite manner. People appeared very comfortable and all were well dressed and clean which demonstrated that staff took time to assist people with their personal care needs.

At lunch time we saw people who lived in the part of the home which cared for people who had a dementia were given meals on plastic plates. Drinks were served in plastic picnic beakers. In the main part of the home food was served on china plates and people were given glasses for their drinks. This practice did not uphold the dignity of people with a dementia.

The home had policies and procedures for the safe administration of medication. There were adequate storage facilities for medicines including storage for medication which required refrigeration. This meant that all medicines could be safely stored at their required temperature.

People who lived at the home were satisfied with the staff who supported them. Comments included; 'The staff are pretty good,' 'The staff are alright they treat me well' and 'The staff are all friendly and will do anything for you.'

The home had systems in place to regularly monitor and assess the quality of the service provided. These included audits and satisfaction surveys.

People who lived at the home said that they were able to make choices about what time they got up, when they went to bed and how they spent their day. One person said 'You decide what you do each day, there's never any pressure.'

Two people in the main part of the home said that they knew about their care plans. Other people asked said that they thought their needs had been discussed with family members when they moved into the home. The home used an electronic care plan system and there was no evidence that people who lived at the home had had input into their care plan. This meant that care plans had not been personalised to reflect individual wishes and preferences.

People we spoke with said that they thought there was usually enough staff on duty to meet their needs. People said that if they rang their bell for assistance then staff responded promptly. We noted that on the day of the inspection call bells were not left ringing for extended periods of time.

People who were able to express an opinion said that they would be able to speak with a member of staff if they were unhappy about the service they received. Two people said 'We would definitely complain if we weren't happy and they would sort it out.'