Archived: Lodge Lane Nursing Home

Lodge Lane Nursing Home is a residential ‘care home’ providing accommodation, nursing and personal care to 20 older people and people who are living with mental health support needs. At the time of the inspection 17 people were living at the home.

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

Risk management procedures and support measures were in place. However, these were not always consistently completed as a measure of monitoring and managing risk.

Risk assessments and care plans had been reviewed and updated since the last inspection. However, they did not always contain the most up to date and consistent information required.

Governance procedures had improved since the last inspection. New systems and processes had been implemented to monitor, assess and improve the quality and safety of care people received. However, further progress and development in this area is encouraged. We have made a recommendation regarding this.

People were supported to maintain maximum choice and control of their lives, staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, processes and systems need to be reviewed in relation to legal documentation. We have made a recommendation regarding this.

Safeguarding measures and reporting procedures had improved. Staff had received safeguarding training, were familiar with reporting procedures and investigations were carried out accordingly. The manager had systems in place to review and monitor safeguarding incidents and referrals.

Staff told us they received an effective level of support from the management team. Supervision and training opportunities had improved, staff were supported to complete required training courses that could help develop their skills and qualities.

Staff were observed providing safe care and treatment in a dignified and respectful manner. The manager confirmed that improvements had taken in place in relation to the culture of the home. We noted that there was no longer an ‘institutional’ feel but a warm, homely and inviting atmosphere.

Staffing levels were routinely monitored. Levels of staff were reviewed and determined in relation to people’s dependency needs. However, we did receive feedback that agency staff have been supporting the home whilst a recruitment drive is carried out.

The provider followed ‘safe’ recruitment practices meaning that people received safe, effective and compassionate care by staff who were able to work in health and social care environments.

Medication processes and procedures were safely in place. Staff received medication administration training and had their competency levels checked. Medication audits were carried out, errors were identified, and lessons were learnt.

Infection prevention control (IPC) measures were in place. The manager and staff followed COVID-19 advice and guidance to minimise the risk of the spread of infection and to keep people safe. Control measures, policies and procedures were rigorously followed; the environment was safe, clean and well maintained.

Rating at last inspection and update:

The last rating for this service was ‘inadequate’ (report published August 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection, which identified the improvements they would make and when actions would be completed. At this inspection we found improvements had been made but the provider was still in breach of regulation 12 (safe care and treatment).

During this inspection the provider demonstrated that improvements have been made and the service was no longer rated as ‘inadequate’ overall, however improvements are still required.

This service has been in 'Special Measures' since February 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as 'inadequate' overall or in any of the key questions. Therefore, this service is no longer in 'Special Measures'.

Why we inspected

A decision was made for us to inspect and follow up on the actions taken following the last inspection and to see whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

Due to the COVID-19 pandemic, we undertook a focused inspection to only review the 'Safe', 'Effective' and 'Well-led' domains. Our report is only based on the findings in those areas at this inspection. The ratings from the previous comprehensive inspection for the ‘Caring’ and ‘Responsive’ key questions were not looked at during this visit.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used to calculate the overall rating at this inspection.

The overall rating for the service has changed from ‘inadequate’ to ‘requires improvement’. 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 Lodge Lane Nursing Home on our website at www.cqc.org.uk.

Enforcement

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.

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 until we return to our inspection programme. If we receive any concerning information we may inspect sooner.

We will also request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Lodge Lane nursing home accommodates up to 20 people who require personal and nursing care for people with enduring mental health needs. At the time of the inspection there were 16 people using the service.

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

The providers systems and processes for assessing, monitoring and improving the quality and safety of the service had not been used effectively. Some audits failed to identify concerns noted during inspection and failed to bring about areas for improvement especially for developing a positive culture within the service. Records were not always accurate and kept up-to-date. The provider reassured CQC that they would take immediate actions following the inspection to help improve and manage the service.

People were not always protected from the risk of abuse. The provider was made aware of an issue regarding a person's deteriorating health. Staff failed to recognise the risk to this person. This concern has been referred to the local authority.

Staff had not been appropriately managed, trained and supported to offer person centred care and choices to people. Staff had not consistently received supervision and appraisals necessary to support them in the workplace. Some staff lacked understanding and insight to people's individual conditions and needs.

People were not always supported to have maximum choice and control of their lives. Institutionalised practices based around rules restricted people's liberties and rights. Staff were not always aware of why rules were in place, for example some people had their snacks stored in the kitchen rather than in their own room. Some staff were unsure why this was done.

Some people and family members commented that some staff were kind and caring in their approach. However, people’s dignity was not always fully respected. People had not been supported to express their views and concerns and they had not received feedback regarding issues they had raised.

We have made a recommendation about staffing . There was a high use of agency staff due to recruitment issues. There has been a period of instability of management personnel and a lack of sharing information with people about staffing

Safe recruitment processes were followed. Checks on applicant’s suitability and fitness had been carried out before they started work at the service.

The environment and equipment used by people had improved and was well maintained.

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 February 2019).

Why we inspected

We found evidence during this inspection that people were at risk of harm.

We have identified breaches in relation to training and support of staff, safeguarding vulnerable adults, dignity and respect, consent and the leadership and oversight of the service at this inspection.

Prompt action was taken by the registered provider during and after the inspection to safeguard people and mitigate risks to them in response to the concerns we found during our inspection.

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

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 how they will make changes to ensure they improve their rating to at least good. We will also request an action plan for the provider to understand what they will do to improve the standards of quality and safety.

We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

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.

People’s experience of using this service:

This comprehensive inspection took place on the 29 and 30 November 2018 and 19 December 2018 and was unannounced.

People who used the service were happy about the service being delivered to them. People told us they enjoyed the food but they had mixed comments depending on which chef was on duty.

We recommend the service review the dining experience and look at trialling various initiatives to help improve this aspect of support for people.

We identified a breach of regulation relating to good governance as we did not see sufficiently established and effective quality assurance systems in place. The provider’s quality assurance processes had not initially identified the issues highlighted during this inspection.

We identified a breach of regulation relating to staff training and support. Staff noted improvements to the service since the registered manager commenced in post. They felt supported and listened to. The registered manager had actions in place to update staff with training and to provide all staff with regular supervision and appraisals.

Staff supported people to take their medicines safely and as prescribed. The registered manager took appropriate on-going actions to offer more person-centred support. This ensured people living at the service could choose when they wanted their medication and where they wanted their medications stored.

Health and safety needed regular oversight and support to consistently manage safe systems at the service. We noted some areas of repair. The quality and safeguarding manager arranged for the repairs during the inspection to help improve the standard of maintenance within the service.

We recommended the service review the environment to access published guidance in developments to meet the needs of people who were living with cognitive impairments and dementia.

People were protected from potential harm and abuse. Staff were knowledgeable of local safeguarding procedures. The provider and staff have recently taken appropriate safeguarding actions following reports of alleged poor practice.

Recruitment procedures were safely managed to minimise the risk of unsuitable people being employed to work with vulnerable people. Agency staff were used for some vacancies and to help provide one to one support for some people at the service. People at the services were unsure how many staff they could expect to see on each shift.

We recommend the registered provider includes staff, people receiving support and relatives in their assessments of staffing levels so they are fully informed and consulted about the staffing levels provided.

Detailed care plans described the support people needed. They included information from external healthcare professionals. People’s health was well managed and the positive links with professionals promoted their wellbeing. People were referred to appropriate health and social care professionals when necessary to ensure they received treatment and support for their specific needs. Staff had followed the Code of Practice in relation to the Mental Capacity Act 2005 (MCA).

Information and arrangements were in place for the staff team to respond to concerns or to a complaint. The provider and registered manager were reviewing this process to encourage more feedback from people living at the service.

Rating at last inspection: At the previous inspection in February 2016 the overall rating was ‘good.’

Why we inspected: This inspection was a planned comprehensive inspection. We had not received information of concern prior to or during the inspection.

Enforcement-Follow up: We found 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. 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.

Lodge Lane Nursing Home provides nursing care and accommodation for up to twenty people with enduring mental health needs. On the day of the inspection 19 people were living at the service.

Accommodation is provided on two floors, with lounges available on both floors. A passenger lift and stairs provide access to the first floor. The dining areas are on the ground floor. There is also a conservatory and a garden at the back and a small car park at the front. Assisted bathing facilities are provided.

The service had a registered manager in post who had worked at the home for 23 years. 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.

Prior to this inspection we received feedback from the local authority contract monitoring, three social workers and a visiting GP. They were very complimentary about the care at Lodge Lane.

The service provided good care and support to people enabling them to live fulfilled and meaningful lives. People told us they liked living there and the staff were kind and supportive.

The interactions we observed between people and staff were positive. We heard and saw people laughing and smiling. People looked comfortable, relaxed and happy in their home and with the people they lived with.

People’s health and well-being needs were well monitored. The registered manager and staff responded promptly to any concerns in relation to people’s health and also encouraged people to attend health checks recommended for their age group and gender. People were provided with information about diet and healthy eating and were fully involved in all aspects of menu planning and meal preparation.

People had their medicines managed safely, and received their medicines in a way they chose and preferred.

People who lived at Lodge Lane were supported to lead a full and active lifestyle. Throughout the inspection we saw people coming and going from the home either independently or supported by staff. Some people went out for short trips to the shops or to visit friends and others were partaking in other planned activities. Activities and people’s daily routines were personalised and dependent on people’s particular choices and interests. People were supported to develop their skills and pursue employment and educational opportunities.

People were able to express their opinions and were encouraged and supported to have their voice heard. People were fully involved in planning and reviewing their care and support needs. All of the files we looked at evidenced that people were involved in decisions about their care.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. Staff had an understanding of the systems in place to protect people who could not make decisions and followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

There was an extremely positive culture within the service, the management team provided strong leadership and led by example. The chief executive and registered manager had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team.

Individualised care was central to the home’s philosophy and staff demonstrated they understood and practiced this by talking to us about how they met people’s care and support needs. Staff spoke in a compassionate and caring way about the people they supported.

There were sufficient numbers of staff to meet people’s needs and keep them safe. The provider had effective recruitment and selection procedures in place and carried out checks when they employed staff to help ensure people were safe. People who used the service were involved in the recruitment process.

Staff were well trained and supported by the organisation. They were encouraged to act as ambassadors for the social care of people with mental health needs.

The provider had a robust quality assurance system in place and gathered information about the quality of the service from a variety of sources including people who used the service and other agencies. Learning from incidents, feedback and complaints was used to help drive continuous improvement across the service.

The service worked in partnership with other organisations, both nationally and locally, to make sure they were following best practice guidance and contributing to the improvement of support for people with mental health needs.