Archived: Francis Lodge Residential Home

We received an action plan from the provider which detailed what they would do to comply with the regulations.

We undertook a responsive follow up inspection on 23 December 2014 to see if the provider took action to comply with Regulation 15 HSCA 2008 (Regulated Activities) Regulations 2010.

We received information from the local authority about concerns for people's safety and welfare in relation to this service. We looked into these concerns as part of this inspection and to answer the following key questions: is it safe, is it effective and is it responsive.

People who used the service were older people with dementia. There were three people using the service however at the time of this inspection we spoke to two people as one person had been admitted to hospital.

We also spoke to one relative, two visiting district nurses, one care worker and the provider. We observed how the staff interacted with people who used the service and looked at how people were supported during the day and meal times.

We reviewed three care plans, one staff file, training records and records relating to the management of the service such as audits, policies and procedures.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Some aspects of the service were not safe. When we arrived at the home, the provider was the only member of staff on duty to provide personal care and support to two people who require full support with their personal care needs. Staff rotas showed and staff told us there were times when they worked on their own and in the morning when people needed personal care it was felt that for three people who require full support with their personal care and mobility, one care worker was not enough however the provider was always available if required. Care plans also indicated that people in the home would require one to one support from care workers. The provider did tell us that she was going to be reviewing the staffing levels in the home.

The provider did not take the appropriate steps to ensure that, at all times, there are sufficient numbers of suitably qualified, skilled and experienced persons in the home to ensure the safety and welfare of people using the service. The provider had failed to comply with Regulation 22 HSCA 2008 (Regulated Activities) Regulations 2010.

The service identified when people were at risk. Risk assessments had been completed which provided guidance on how to minimise risks for people.

Is the service effective?

The service was effective. People were cared for by staff that felt they were supported to have the necessary knowledge and skills they needed to carry out their roles and responsibilities.

People were supported to be able to eat and drink sufficient amounts to meet their needs and had access to health and medical services.

Is the service responsive?

The service was responsive. Care plans were person-centred and specific to each person and their needs. People's care preferences and routines were clearly reflected in their plan of care.

We spoke with three people who were currently using the service, and four members of staff, including the provider. We observed how staff interacted with people who used the service.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Assessments were carried out and reviewed regularly for aspects of health and safety. Care plans and risk assessments, for example for mobility, personal hygiene and communication, provided details of how best to support each person. However there were no risk assessments in place to ensure that people using the service used the steps to the garden and the stair lift to the first floor safely

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

Staff we spoke with told us that they felt well supported and received appropriate training and supervision to enable them to carry out their responsibilities and to care for people appropriately.

People were provided with a choice of suitable and nutritious food and drink and staff supported them to eat and drink sufficient amounts to meet their needs. Care plans recorded how each person ate and the support they needed. Staff were aware of the need to assess people for the risks of poor nutrition, and the signs that they should be aware of.

Is the service caring?

Care plans contained information about each person's specific needs for staff to follow.

People expressed their views and were involved in making decisions about their care and treatment. Care plans showed how people preferred their care to be provided.

We observed that staff interacted with people in a respectful and sensitive manner. They took time to assist people and spoke with them while they assisted them.

Is the service responsive?

The provider carried out satisfaction surveys and monitored the responses and any concerns.

We saw that staff carried out monthly evaluations of each person's individual care plans and that care plans were updated when required.

Is the service well-led?

At the time of our inspection the provider did not have a registered manager in place.

Staff we spoke with said that the provider gave them with good support and they were clear about their roles and responsibilities.

The provider had an effective system to regularly assess and monitor the quality of service that people received. They carried out regular health and safety audits of the premises and annual quality surveys of the views of people using the service and their family members.

People who used the services received appropriate care and support that met their individual needs and they were treated with dignity and respect.

There were processes in place to protect people using services from harm. The staff were trained to recognise the signs of abuse and to report concerns in accordance with the home's procedures.

The staff were supported to provide care and treatment to people who used the service and were being trained, supervised and appraised appropriately.

There was an effective complaints system available.

We found people had comprehensive care assessments that included their wishes and views. We found the systems in place prevented people receiving inappropriate or unsafe care.

We observed that the environment people were cared for in was clean and that the provider had systems in place to reduce the risk of the spread of infections.

We looked at how medication was administered and found that there were systems in place to ensure that people received their medication correctly.

We found at a previous inspection in July 2011 that people were not always cared for by sufficient numbers of staff. We found at this inspection that the provider had made improvements and people were now cared for by sufficient numbers of staff.