Harrogate Lodge Care Home

Updated 3 August 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Harrogate Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Harrogate Lodge is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a manager in post who had started their role recently and had submitted an application to register.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 29 June 2022 and ended on 12 July 2022. We visited the location’s office/service on 29 June and 7 July 2022.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

We reviewed information we held about the service including information about important events which the service is required to tell us about by law. We requested feedback from other stakeholders. These included the local authority safeguarding team, commissioning team, infection and prevention control team and Healthwatch Leeds. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all of this information to plan our inspection.

During the inspection

We spoke with nine people using the service and four relatives about their experience of the care provided. We observed care in the communal areas to help us understand the experience of people. We received feedback from one healthcare professional.

We gathered information from several members of staff including the home manager, deputy manager and nurses.

We reviewed a range of records. This included five people's care plans, risk assessments and associated information, and other records of care to follow up on specific issues. We also reviewed multiple medication records. We looked at three staff files in relation to recruitment and training. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 3 August 2022

About the service

Harrogate Lodge Care Home is a care home with nursing and is registered to provide accommodation for up to 50 persons who require nursing or personal care. The home provides intermediate care in the ground floor, which supports hospital discharge through rehabilitation to help people regain previous levels of independence. The first floor accommodates mostly people living with dementia. At the time of our inspection, there were 47 people living at the service.

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

The service was not always managed well. Quality assurance systems were in place and happening regularly, however these had not always been effective in identifying the issues or in driving the necessary improvements identified at this inspection. We found records related to people’s care were not always complete or contemporaneous.

We found risks to people’s care were not always well managed. Some risks to people’s care were assessed and measures put in place to manage these, such as risk of falls. However, we saw examples of other risks not always being well managed such as behaviours considered challenging to others or equipment used to support people’s posture. We found some people did not have an up to date personal emergency evacuation plan.

We received mixed feedback from people and staff in relation to the staffing levels at the service. We observed communal areas were, at times, left unsupervised by staff. Dependency levels were being considered for one area of the home, but not for another. The manager told us they had already identified this was an issue and told us their ongoing work to review staff’s deployment, rotas and recruitment. We recommend the provider reviews their staffing levels taking into consideration dependency levels in both floors.

People and relatives told us the care received at the service had a positive impact on people. We received positive feedback regarding staff being kind and caring. Most staff told us they felt well supported.

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 service supported this practice.

We saw evidence of good partnership work with other professionals, to meet the needs of people using the service.

There were plans to continue developing the service, around improvement of care plans and dementia care. There were also plans to renovate the home.

The management team supported this inspection, were receptive to findings and acted timely on the concerns identified.

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

Rating at last inspection

The last rating for this service was good (published on 14 November 2017).

Why we inspected

This was a planned inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

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 monitor the service.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

We made a recommendation for the provider to review good practice guidance in relation to safe staffing levels.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.