Homer Lodge Care Centre

Homer Lodge Care Centre is a residential care home providing personal care to up to 47 people. The service provides support to people aged 65 and over. At the time of our inspection there were 32 people using the service.

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

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.

Staff were kind and caring. They supported people’s independence and respected people’s choices. There were enough staff to meet people’s needs and they had received the training and support needed to provide safe care. Staff were knowledgeable about how to keep people safe from harm and were confident to raise any concerns they had.

People received an initial and ongoing assessment of their needs and care plans reflected their individual needs. Risks to people were identified and care was planned to keep them safe. Where needed equipment was in place to support safe care. People’s wishes at the end of their lives were recorded and care was in place to keep people pain free as they neared the end of their lives.

The home was clean and staff worked to minimise the risk of cross infection. Medicines were safely managed and available to people when needed.

People were complimentary about the quality of food provided. Their abilities to eat safely and maintain a healthy weight were assessed and where needed people were referred to healthcare professionals.

The provider was updating the environment and considered people’s needs in the improvements being made.

The provider had systems in place to monitor the quality of care provided. This consistently identified issues and action was taken to improve the care people received. Safeguarding, incidents and complaints were investigated, and action taken to keep people safe.

The registered manager was approachable and well-liked by people living at the home, relatives and staff. Staff felt able to approach the registered manager with any issues.

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 (20 October 2022) and there were breaches of regulation. We issued warning notices for regulation 12 safe care and treatment and regulation 17 good governance. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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

Follow up

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

Homer Lodge Care Centre is registered to provide accommodation and personal care for up to 47 people. At the time of our inspection there were 29 people using the service. People were accommodated over three floors.

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

There were organisational governance processes in place to monitor the quality of the service. However, these were not always operated robustly as they did not identify concerns found on inspection.

Risks were not always managed. Accident and incidents were not always identified or recorded posing additional risks to people.

Staff did not always have up to date training to ensure they could carry out their role safely and effectively. Systems in place to monitor training were inconsistent, meaning gaps were not identified and training was not always completed in a timely way.

Care plans detailed how to support the person to ensure their assessed needs could be met. We found some care plans required further work to ensure they contained current up to date information to meet people’s needs. The provider was in the process of changing to an electronic care planning system.

Safe recruitment systems and processes were in place, with relevant background checks completed. People told us they felt safe. People and staff provided positive feedback on the management of the service.

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.

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 requires improvement (published 18 June 2021). The service remains rated requires improvement.

Why we inspected

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.

The inspection was prompted in part due to concerns received about quality of care, staff training and competencies and governance. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Homer Lodge Care Centre 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. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to risk management, staffing and governance at this inspection. Please see the action we have told the provider to take 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 request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Homer Lodge is a residential care home providing personal and nursing care to 21 people aged 65 and over at the time of the inspection. The care home can accommodate 47 people in a single building.

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

Staff had access to personal protective equipment (PPE). Staff did not consistently follow guidance regarding donning and doffing of PPE and hygiene.

The home was clean, and an infection control policy was in place. Quality monitoring arrangements were in place but these had not identified some of the issues we found on inspection.

Medicines were administered and managed safely. Medicine guidance for ‘as required’ medicines (PRN) was in place.

There were enough staff to meet people’s care needs. Staff had received training for their roles. New staff were recruited safely.

The risks to people’s care were assessed and measures were in place to mitigate these risks. People were cared for safely.

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.

Staff knew how to keep people safe from abuse and were confident to raise concerns with the registered manager or external agencies. When required, notifications had been completed to inform us of events and incidents.

People and their relatives knew how to raise a complaint and would feel confident to do so if needed.

People had access to a range of professional support and working arrangements were in place with healthcare professionals.

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 8 February 2019).

Why we inspected

We received concerns in relation to care and staff not following infection control procedures. As a result, we undertook a focussed inspection to review the key questions of safe and well-led only.

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.

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

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

Follow Up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the time of our inspection 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.

The service had previously been rated as ‘requires improvement’ in 2017. At this inspection the service was rated as ‘Good’.

The provider had ensured that there was usually a sufficient number of staff on duty. People told us that they received person-centred care. Sufficient background checks had been completed before new staff had been appointed according to the provider’s policy. A system was in place to carry out suitable quality checks and appropriate checks had been regularly carried out.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. The environment was clean. Staff followed arrangements to prevent and control infections.

Guidance was in place to ensure people received their medicines when required. Processes were in place to manage medicines.

Where people were unable to make decisions, arrangements were in place to ensure decisions were made in people's best interests. Best interests decisions were specific to the decisions which were needed to be made.

Care was not always delivered in line with current best practice guidance.

Arrangements were in place to ensure staff received training to provide care appropriately and effectively. People were helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have choice and control of their lives. Staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were not treated consistently with dignity and respect. People were usually treated with kindness and compassion and they were given emotional support when needed. They had also been supported to express their views and be involved in making decisions about their care as far as possible. People had access to lay advocates if necessary. Confidential information was kept private.

Information was provided to people in an accessible manner. People had been supported to access a range of activities. People were supported to access local community facilities. The registered manager recognised the importance of promoting equality and diversity. People’s concerns and complaints were listened and responded to improve the quality of care. Arrangements were in place to support people at the end of their life.

The registered manager encouraged a positive culture in the home. Staff had been helped to understand their responsibilities to develop good team work and to speak out if they had any concerns. People, their relatives and members of staff had been consulted about making improvements in the service. There were arrangements for working in partnership with other agencies to support the development of joined-up care.

Further information is in the detailed findings below.

At our previous inspection on 21 September 2016 we found that the provider did not have effective systems to assess and monitor the quality of service provided to people. We also found that there were not effective and safe systems in place for the management and administration of medicines. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focussed inspection on 16 March 2017 to check that they had followed their plan and to confirm that they now met legal requirements. At our inspection on 16 March 2017 we found the provider had not made the necessary improvements.

This report only covers our findings in relation to those requirements. You can see what action we have told the provider to take at the back of the full version of this report. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Homer Lodge on our website at www.cqc.org.uk.

Homer Lodge provides care for older people who have mental and physical health needs. It provides accommodation for up to 47 people who require personal and nursing care. At the time of our inspection there were 31 people living in the home.

At the time of our inspection 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.

Medicines were not managed safely. Arrangements were not in place to ensure people received their ‘as required’ medicines (PRN) appropriately. Medicine records were not completed fully.

Systems were not consistently in place to assess and monitor the quality of the service provided for people. The provider told us what actions they would take to make improvements and we found at this inspection that the improvements had not been sufficient to meet legal requirements. The provider had started to carry out some audits on a regular basis however medicine audits did not identify some of the issues we found at this inspection. The provider had not complied with their medicines policy. The provider did not have systems in place to ensure that people received their medicines as prescribed.

At this inspection we found the provider had made some improvements in the management of medicines but identified further issues relating to the management of medicines. We also found the provider had failed to meet a recommendation we made in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The provider had failed to address all the issues raised at previous inspections.

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

Homer Lodge provides nursing and residential care for older people. It provides accommodation for up to 47 people who require personal and nursing care. The service provides care on three floors. At the time of our inspection there were 31 people living at the home.

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.

The provider’s audit processes had failed to identify the issues we found at our inspection regarding medicines and MCA. The provider had also failed to fully address the issues raised at our previous inspection in September 2016 in relation to the MCA and best interest assessments.

Systems and processes were not for the safe management of medicines were not consistently effective.

Where people could not consent assessments to ensure decisions were made in people’s best interest had not been consistently completed. We saw that staff obtained people’s consent before providing care to them.

People told us there were not always sufficient staff available to meet people’s needs. Staff responded in a timely and appropriate manner to people during our inspection. Staff were kind and sensitive to people when they were providing support. People were treated with respect.

People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place. Staff had received supervision and appraisals. People were provided access to leisure and social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to.

Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

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.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe. However risk assessments had not always been completed. We have made a recommendation about the use of slings.

Medicines were not consistently administered safely. We saw that staff obtained people’s consent before providing care to them. The provider acted in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find. We have made a recommendation about MCA & DoLS.

We found that people’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support. People did not always have their dignity considered. Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received regular supervision. People were encouraged to enjoy a range of social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Regular audits were carried out and action plans put in place to address any issues which were identified. The process had failed to identify some of the issues we found at inspection. Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

We considered our inspection's findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? This is a summary of what we found:

Is the service caring?

We found that the service was caring. This was because people said that staff were respectful, kind and attentive. They considered staff to be genuinely committed to helping them. Relatives were confident that staff were polite and courteous to people who used the service.

People were offered the opportunity to engage in a range of social activities. These included having one to one sessions with the activities coordinators, taking part in small group activities such playing board games and going on trips out.

Is the service responsive?

We found that the service was responsive. This was because staff knew about each person's choices and preferences about the care they wanted to receive. People said that their care needs were met in a flexible way. This involved staff being happy to adjust the assistance they provided according to people's changing needs and wishes.

However, we identified some defects in the accommodation. These reduced people's ability to receive care in a comfortable and dignified setting. We have said that the provider may find it useful to make some improvements to further develop the service. These involve completing the repairs and redecoration necessary to ensure that all parts of the accommodation are finished to a normal domestic standard.

Is the service safe?

We found that the service was safe. This was because the provider had made arrangements to reliably implement the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. These measures are designed to ensure that people who have reduced capacity to make decisions receive the support they need so that they are protected from abuse.

We found that a number of important checks had been completed to ensure that new staff were trustworthy to care for vulnerable people. However, we have said that the provider may find it useful to make an improvement to further develop the service. This involves making additional checks on applicants who have previously worked in care settings. This is necessary so that assurances can be obtained about their good conduct.

Is the service effective?

We found that the service was effective. This was because people's individual needs for care had been properly assessed and they were receiving all of the nursing, rehabilitation and care services they needed. In addition, staff had ensured that people had seen their doctor and other healthcare professionals when necessary.

There were safe systems for ordering, administering and dispensing of people's medication. However, we found that some of the storage facilities in the medication room were not robust. We have said that the provider may find it useful to make an improvement to further develop the service. This involved ensuring that all medicines are stored in metal cabinets.

The number of staff employed and the way in which their work was organised enabled the provider to meet people's needs for care. However, the provider did not have a robust system for deciding when staffing levels needed to be altered in order to respond to people's changing needs. We have said that the provider may find it useful to make an improvement to further develop the service. This involves developing a clear and recorded system to assess how many nurses and care assistants are needed at any particular time.

Is the service well lead?

We found that the service was well led. This was because people had been consulted about their experience of using the service. This meant that they could contribute ideas for improving the service.

There was a clear line of management. This meant that important decisions about organising someone's care were made by nurses. At the same time care assistants could use their own judgement for routine matters in order to provide a flexible service.

Records showed that a number of quality checks had been completed. These included care records and various health and safety matters. However, we concluded that checks of accommodation were not robust. This was because they had not always identified and quickly resolved obvious problems. We have said that the provider may find it useful to make an improvement to further develop the service. This involves ensuring that effective checks are completed of the environment so that any defects can be quickly put right.

People who lived at Homer Lodge Care Centre were treated with dignity and respect. One person said: "They check me but close the doors so that I have my dignity".

We checked care plans and risk assessments but found the information was not person centred and did not provide the detailed guidance necessary for staff to ensure people's care and support needs were met.

Prescribed medication for some people was not available in the home, which meant people's health care needs were not met.

Staff we spoke with said they felt there were enough staff available to meet people's needs most of the time, but when sickness and holiday cover was needed it meant staff worked long hours. They all said they had received the training they needed to ensure people's care needs could be met.

There was a complaints system in place to ensure people could raise concerns and that they would be dealt with appropriately.

Where people were unable to give consent, we saw appropriate discussions were held with people such as relatives who knew them well.

People said they were satisfied with the care they received and said their privacy and dignity was respected. Relatives also commented positively. For example, a relative said, 'We can't thank them (staff) enough they are wonderful, I can go home and sleep at night.'

People told us they felt safe and comfortable to talk to staff if they had any problems and thought they would be dealt with.

People said they were satisfied with the cleanliness of the home and we saw there was a programme in place to redecorate and refurbish bedrooms and communal areas. A relative said, 'Staff always wear aprons and gloves, use the hand wash and encourage us to do the same.'

People told us they were well looked after and the staff were 'Lovely.' Staff said they were well supported. However we spoke with the manager about making sure staff learning and development records were up to date and accurate.

There were satisfactory systems in place to monitor the quality of the service which took into account people's views. People said they knew how to and felt comfortable to raise concerns.