Loganberry Lodge

Loganberry Lodge is a residential care home providing accommodation and personal care to up to 141 people, including people living with dementia. At the time of our inspection there were 139 people using the service.

Loganberry Lodge accommodates people across six distinct units, each of which has separate adapted facilities. There are four units in the main Loganberry Lodge building, as well as the laundry and kitchen, and two units in a separate adjacent building known as Huckleberry.

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

Staff were kind and caring, but observations and people’s feedback told us there were not always enough staff effectively deployed to meet people’s full range of support needs. Care plans and risk assessments were in place to support staff to deliver care safely. Whilst staff understood safeguarding responsibilities, further analysis was required to support lessons learned. Medicines were given safely and as prescribed. Infection prevention and control measures were in place. Staff recruitment and oversight was safe.

We received mixed feedback about food available at Loganberry Lodge, including the impact of staff serving meals to a large number of people at the same time. There were some improvements required to ensure best use of communal spaces. Staff received training in a range of areas to meet people’s needs and were encouraged to gain qualifications. Records showed assessments had been carried out relating to people's mental capacity and records kept of best interests decision making.

There was positive feedback about the management of the service, including approachability and good communication. However, some issues we identified during the inspection had not been previously noted or resolved. Some systems and processes required further development to show how improvements were made and sustained from feedback or analysis of themes and trends. The service worked in partnership with other health and social care professionals.

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 expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of the effective key question, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. This was in relation to the care setting, as the service is large, which does not follow usual best practice for accommodating people with a learning disability.

However, the registered manager told us that there were a very small minority of people with a learning disability living at Loganberry Lodge who had been accommodated for a long time at the service, were settled and happy, and that their learning disability was not their primary care and support need. They also informed us they would not be admitting any new people with a learning disability to the service and would ensure they were up to date with the guidance above. Staff had also been assigned training on autism awareness and how to support a person with a learning disability.

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 good (published 4 March 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. This included concerns in relation to high staff turnover, high level of accidents and incidents and the admission of people with a learning disability. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

We inspected and found there was a concern, however, with the quality of food and the use or adaptation of the environment to meet people’s needs, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Loganberry Lodge on our website at www.cqc.org.uk.

Recommendations

We have made a recommendation about review of staffing levels and deployment, and a recommendation about the provision of food at Loganberry Lodge.

Follow up

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

Rating at last inspection: Requires Improvement (Published 20 February 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

People’s experience of using this service:

Since the last inspection the service had improved in several key areas and met the characteristics of ‘Good’.

People received personalised care from staff who knew them well. People told us they were happy living in the service and staff were kind and caring.

There were clear systems in place to recruit staff and ensure their suitability before they started work at the service. Staff were observed to be busy at key points in the day, but people told us staff were mostly available when they needed them. Staff received training to develop their skills and enable them to meet people’s needs.

Risks to people’s safety had been considered and steps taken to reduce the likelihood of harm. The environment was well maintained. People benefited from clear signage which helped them to orientate themselves around the building and stay independent.

Meals were nicely presented and looked appetising and people told us they enjoyed the food.

Medicines were managed safely, and practice followed professional guidance.

People had access to a range of health care professionals and support. Where risks were identified to an individual’s health or welfare, referrals were made to the relevant healthcare professionals for support and guidance.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Care plans were detailed and informative and underpinned the delivery of care. There were a range of activities provided to enhance people’s wellbeing.

People’s views were sought, and the information used to make changes to areas such as activities and catering.

Staff were supported in their role and received regular supervision. Staff were motivated and told us the service and the care provided had improved. They expressed confidence in the management of the service.

The registered manager had worked in partnership with local services including the local safeguarding authority and quality improvement teams to improve quality and safety monitoring systems.

The provider had a framework to monitor performance and drive improvement. This included the collection and analysis of data as well as regular audits.

Follow up: We will continue to monitor information 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

Loganberry Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Loganberry Lodge is registered to provide care and support for up to 138 people, some of whom live with a diagnosis of dementia. Care is provided across four units in the main building and a separate unit called Huckleberry located adjacent to the main building. There were 133 people in residence when we inspected.

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 our last inspection of the service on 1 June 2017, we rated the service as "Requires Improvement" overall but as inadequate in the key question of Safe. This was because we found deficiencies in the way medicines and staffing were managed. We found that the provider was in breach of a number of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service was placed in special measures as the service had been rated ‘Inadequate’ in Safe over two consecutive comprehensive inspections. We took enforcement action and issued warning notices setting out our concerns and the actions the provider needed to take to improve. Following the inspection the registered provider sent us an action plan setting out the steps they would take to address the concerns. At this inspection we found that improvements had been made and as a result were no longer in special measures, although the overall rating remains ‘Requires improvement.’

Medicines were managed in a safer way. Medicines were stored securely in clean and tidy treatment rooms, and the temperatures of the storage areas were recorded regularly. Our observations and a review of the records showed that medicines were administered as prescribed. We have however recommended that the provider review medicine procedures and protocols to further protect people. This should include the management of diabetes and distressed behaviours, as well as the guidance available to staff on supporting people at the end of their life.

At this inspection we found that there had been improvements to staffing. The service was fully staffed and was no longer dependent on agency staff which meant that people were supported by a consistent team of people who knew them. However the feedback from people was not consistently positive and some people continued to express concerns about the availability of staff. The registered manager provided assurances that they closely monitored staffing levels and told us that they intended to make further changes to deployment to take account of the comments made at the inspection. We have recommended that the provider keep staffing levels under close review to take account of peoples changing needs.

Staff demonstrated a good awareness of safeguarding procedures and knew who to inform if they witnessed or had an allegation of abuse reported to them. The registered manager had made appropriate referrals to the local authority when they had concerns about people’s wellbeing. They were aware of their responsibilities under their duty of candour.

Risks were identified and management plans were in place to guide staff on how to reduce the likelihood of harm. The management plans were informative but staff did not always recognise potential risks or consistently follow the plan. The environment was regularly monitored and checks were undertaken on equipment to reduce the likelihood of equipment failure. Staff understood the need to report safety incidents and any concerns. Staff received training in infection control and protecting people from infection but did not always implement their training.

The Mental Capacity Act (MCA) 2005 provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The registered manager understood their responsibilities but staff were less clear. People had capacity but key documents had been signed by family members who did not have the legal authority to consent on their behalf. It was agreed that the registered manager would review the records and guide staff appropriately.

There were systems to check on staff suitability prior to them starting work at the service which included references and disclosure and barring checks. There was an induction, training and development programme, which supported staff to gain relevant knowledge and skills. However, further efforts were needed to consolidate learning and best practice in key areas such as dementia care, infection control and moving and handling people. We received assurances from the registered manager that they were accessing additional training and reviewing staff competency across the service.

People received regular and on-going health checks and support to attend appointments. The registered manager was looking at ways to improve communication with health professionals to drive improvements at the service.

People were offered choice and supported to eat and drink. The service was in process of piloting a change to meal delivery but people raised issues with us about how this was working and the impact on them. We observed that the organisation, presentation and delivery of meals could be improved in some parts of the service. The registered manager assured us that they were working with people to address the issues raised following the introduction of the pilot scheme.

People and their relatives were complimentary about the attitude of the staff and told us they worked hard to meet people’s needs. We saw staff were kind and caring and had developed good relationships with people using the service. People were supported to make choices and to be as independent as they could be.

Preadmission assessments were undertaken but were not always as comprehensive as they could be and did not ensure continuity of care. Care plans were in place to guide staff but some did not provide sufficient guidance, for example in supporting people with dementia and in planning for people’s end of life care.

People had access to a range of organised activities to promote their wellbeing. People spoke positively about what was available and we saw that a new café had been developed in one part of the service. However we have recommended that further efforts should be made to enhance the lives of people with dementia.

Complaints were investigated in full and were responded to in a timely way. The service sought the views of people and others about the quality of the service provided. The findings were used to drive improvement.

There was visible leadership and people told us that the new management team were approachable and supportive. The service was improving and the culture was more positive. The registered manager had a plan to address the issues we identified about consistency of practice.

The registered manager and area manager completed a range of audits to monitor the safety and quality of the service. For example, there was routine auditing of care plans, analysis of accidents and incidents and checks on staff competencies. The information was analysed and action plans were generated in response to promote people’s welfare and safety.

During this inspection we identified a breach 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 this report.

Loganberry Lodge is registered to provide care and support for up to 138 people, some of whom live with a diagnosis of dementia. Care was provided across four units in the main building and a separate unit called Huckleberry located adjacent to the main building. There were 132 people in residence when we inspected.

The service had a registered manager. 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.

We previously inspected the service on 22 and 29 November 2016 and the service was found to be in breach of a number of the legal requirements and rated inadequate in safe. The provider put in additional management support and sent us an action plan which set out the improvements that they intended to make. This inspection was undertaken to follow up on the concerns and check that progress had been made. We found that this was an improving service but there were still areas which required further work. At this inspection we found that medication procedures were not in line with best practice ,they did not work effectively or offer adequate protection to people. The provider was due to change to a new provider and had started the process of training staff on this new system.

Staffing levels had been improved and staff were more visible however, we identified issues with the deployment of staff and staffing levels at specific times.

Safeguarding was understood by staff and we saw that the manager followed the procedure when concerns were raised. There were arrangements in place to check on staff suitability as part of the recruitment process but we have made a recommendation to further strengthen the system in place.

Risk management plans were in place to address risks to individuals such as those from skin damage and falls but further efforts were needed to ensure consistency. Checks of the building, equipment and maintenance systems were regularly undertaken to ensure people’s health and safety was protected.

Staff had access to a wider range of training which meant that they were better equipped to meet the needs of people using the service however further oversight was needed to ensure that staff were putting their training into practice.

Responsibilities with regards to the Mental Capacity Act 2005 were better understood by staff. The manager told us that they were working towards reducing the restrictions on people’s movement around the building.

People’s nutritional needs were assessed and improvements had been made to how people were supported to eat and drink. Concerns were raised about the quality and timings of meals, however the manager assured us that they had already identified this issue and had a plan to address it.

People were supported to access ongoing healthcare support.

Staff had good relationships with those they supported however interactions were largely based around the completion of a task.

Assessments were undertaken to identify people’s care and support needs. People’s care and support plans contained information about people’s needs and personal choices however they varied in quality. Key information had not been included for some individuals and staff were not always familiar with the contents. Monitoring systems for the delivery of personal support were not always working effectively.

There was a range of activities available for people to participate in.

The provider had a system in place for responding to people’s concerns and complaints. Any issues were investigated and dealt with appropriately by the manager.

There had been improvements in managerial oversight of the service. Senior staff were more available and accessible, staff and people who used the service were positive about these changes. A range of audits had been undertaken to help identify any areas that required improvement. Changes were in the process of being made but not yet complete.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

We identified a number of breaches of regulation and you can see what action we told the provider to take at the back of the full version of the report.

Loganberry Lodge is registered to provide care and support for up to 138 people, some of whom live with a diagnosis of dementia. Care was provided across four units in the main building and a separate unit called Huckleberry located adjacent to the main building. There were 132 people in residence when we inspected.

The service had a registered manager. 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 spoke positively about the staff but told us that they were not always available in sufficient numbers when they needed them. Our observations were that staffing levels were not sufficient and this meant that people did not always receive personalised care or that risks were well managed.

The systems in place to mitigate risks to individuals from choking, falls and moving and handling did not work effectively and needed strengthening. Medication was not consistently well managed so for example, people were not always receiving creams and lotions that they were prescribed.

Safeguarding was understood by staff and we saw that the manager followed the procedure when concerns were raised. There were clear arrangements in place to check on staff suitability as part of the recruitment process.

People’s nutritional needs were not always well managed. There was a lack of organisation and oversight which meant that people did not always receive the help and support they needed. Guidance regarding supporting people with their dietary needs were not always followed.

Training did not equip staff with the knowledge they needed to work safely and effectively. Key pieces of legislation such as the Mental Capacity Act was not always understood by staff and put into practice. Some of the restrictions which were in place around the environment were not always the least restrictive.

Staff had good relationships with those they supported and worked hard however they had limited time to spend with people. There were care plans in place but they were not always up to date and this meant that staff were not all working in a consistent way and people did not always receive the care they needed.

Activity staff were enthusiastic and provided people with regular activities which promoted their wellbeing. This was one of the strengths of the service.

Overall we found a service of contradictions where there were examples of good practice alongside poor care. There was a lack of consistency throughout the service and audits were not effective as they were not identifying or addressing these issues. The management was stretched and the two deputy managers were not working on a supernumerary basis which meant they were not able to provide the leadership that was needed.

We identified a number of breaches of regulation and you can see what action we told the provider to take at the back of the full version of the report.

On 17 January 2014, we were provided by the service with a monitoring form which the manager had devised for the recording of diabetic information. The manager informed us that they had discussed the situation with the district nursing community matron and agreed how the monitoring and recording of diabetic information would be achieved. The manager also confirmed to us that nursing staff would continue to visit the service at an agreed time each week for the purpose of reviewing individuals nursing care needs. We spoke with the manager on 14 February 2014 and were assured the newly introduced recording form was working well.

One person said that, "The care here could not be better." Another person said, "It is blooming marvellous the way they look after me." A relative informed us how helpful and supportive the manager was to them and their relative.

We found the service had a robust recruitment process in place and staff had been trained with regard to safeguarding. The service worked closely with the district nursing team and supported people to make choices with regards to the way they lived their lives.

The service had quality and monitoring processes in place particularly audits, but we found that the provider was not monitoring the conditions of some people who used the service with regard to their diabetic care and needs.

People told us that they chose what they wanted to do in their lives and that the staff listened to them and acted on what they said. One person said, 'I choose what I want to eat and when I get up in the mornings.' Another person said, 'The staff listen to what I want to do.'

People told us that the staff treated them with respect and kindness. One person said, 'We get along nicely.' Another person said, 'The staff very kind.' Another said, "They (staff) are very nice people." Another person pointed to a staff member and said, "(Staff member) is a dream." This was confirmed in our observations during our inspection. We saw that staff interacted with people in a caring, respectful and professional manner.

We looked at the care records of five people who used the service and found that people experienced care, treatment and support that met their needs and protected their rights.

Staff personnel records that were seen showed that staff were trained and supported to meet the needs of the people who used the service.