White Lodge Care Home

White Lodge Care Home is a residential care home providing accommodation and personal care to up to 23 people. The service provides support to older adults, some people living with dementia and people with physical disabilities. At the time of our inspection there were 16 people using the service. There were 14 staff employed.

The care home accommodates people across three floors. Each person has their own bedroom; some people have ensuite bathrooms and toilets. There are shared communal areas including a dining room and three lounge rooms.

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

Some risk assessments for premises and equipment were completed but others had lapsed or were not followed through. Risk assessments for personal care were satisfactory. Not enough staff were always deployed to ensure the safety of people and ensure they received support in a timely way. People received their medicines appropriately, but improvements were needed to storage, checks and disposal of medicines. The infection prevention and control required improvement due to personal protective equipment storage, and lack of robust cleaning procedures. Most incidents and accidents were logged and there were some lessons learned processes evident. Care workers were patient and kind to the service users, especially those with behaviours that challenge and those walking with purpose. Safeguarding events were logged and referred to the local authority however improvement is required.

There is a schedule of audits in place. Various audits were completed but did not always pick up shortfalls. However, where requirements for improvement were identified by the home manager, they were added to an action log and progress on the actions was documented. There were staff meetings held to discuss various issues. Staff training was up to date and there were regular supervisions and performance appraisals. There have not been any staff surveys, however there were staff meetings. There were relatives' meetings and surveys were sent out to gather feedback. The provider failed to obtain the documents required as part of the regulation and schedule for 'fit and proper persons'. The nominated individual, whilst present in the location several times per week, was reliant on the home manager and deputy manager for ensuring compliance with regulations and standards. The nominated individual did not thoroughly examine the practices of the management team to check if there was good governance. Some documents were not able to be found or located, and they were often referred to as being stored elsewhere but not produced when requested. The home manager and deputy manager worked well together, and staff appeared satisfied working at the care home. People and relatives were satisfied with the care provided.

People were supported to have maximum choice and control of their lives and staff supported /did not 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 good (published 3 August 2019).

Why we inspected

We received concerns in relation to medicines, infection control, staffing and leadership. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

The provider has already taken some action to mitigate the risks to people because of our inspection.

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 from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. 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.

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

Recommendations

We made a recommendation about the prevention of falls at the service.

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.

We found the following examples of good practice.

Staff received training in infection prevention and control and were able to describe the correct use of personal protective equipment (PPE). The provider ensured there was a stock of appropriate PPE available.

Regular COVID-19 testing regime was in place for both, the people living at the home and the staff.

People were supported to see their relatives safely. The provider adapted one of the ground floor bedrooms into a designated visiting area that could be used as an alternative to visiting people in their bedrooms.

There were measures in place to ensure visiting professionals had been informed of the requirement surrounding safe visiting prior to coming into the service. These included the requirement to show proof of a negative lateral flow device’s test result and the requirements to use the appropriate PPE.

The management team described several enhanced infection control measures that had been put in place where people needed to isolate. These included additional PPE, designated red bags for laundry and ensuring careful allocation of staff to reduce the risk of cross infection.

Staff reported good support from the local health professionals.

White Lodge Care Home provides accommodation and personal care for older adults. White Lodge Care Home is a period country house situated in the village of Bisham, near Marlow. The home and has 21 bedrooms, located across three floors. The location is registered to accommodate up to 23 people. At the time of inspection 15 people were living in the home.

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

Since our last inspection the provider had successfully implemented our recommendations. They had worked with a pharmacist and had improved the management of people’s prescribed medicines, to ensure they received them safely. The provider had also implemented a comprehensive system for the prevention and control of Legionella.

People consistently told us they felt safe living in the home. Risks to people were identified, assessed and managed safely. Staff had completed the required safeguarding training and understood their role and responsibilities to protect people from abuse and avoidable harm. The registered manager ensured enough suitable staff with the right skills were deployed to provide people with safe care. Staff maintained high standards of cleanliness and hygiene in the home, which reduced the risk of infection and followed correct procedures whenever food was prepared or stored. Accidents and incidents were reviewed, and the registered manager took action to prevent a recurrence.

People experienced effective care and support which consistently achieved successful outcomes and promoted a good quality of life. The provider enabled staff with the necessary skills, knowledge and support to deliver effective care in line with recognised best practice. People were supported to eat and drink enough to maintain good health. The service worked well with other organisations to ensure prompt referrals to healthcare services when people’s needs changed. 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 treated people with compassion, kindness, dignity and respect. People and relatives consistently told us staff made them feel valued and listened to. Staff supported people to express their views by involving them in developing their care plans and making decisions about their care. Staff responded in a timely and caring way when people experience physical pain, discomfort or emotional distress.

People consistently receive individualised care that was tailored and responsive to their needs. Staff identified the communication needs of people with a disability or sensory loss and effectively shared this information with others when required. People were supported to engage in stimulating activities of their choice and to maintain relationships with people that were important to them. People knew how to make a complaint and were confident the provider would address their concerns. Complaints were listened and responded to and were used to improve the quality of people’s care. The provider had received compliments from relatives in relation to the compassionate care provided to their family members at the end of their life.

The service was well-led, with the registered manager providing clear and direct leadership and a safe environment which had cultivated a positive, open and empowering culture.

Rating at last inspection:

The last rating for this service was good (report published 20/12/2016).

Why we inspected:

This was a planned comprehensive inspection.

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 we receive any concerning information we may inspect sooner.

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

At the time of the inspection, there was 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.

Since transitional registration under the Health and Social Care Act 2008 in January 2011, White Lodge Care Home has not always maintained compliance with the relevant regulations at each inspection by CQC. The most recent inspection was an unannounced comprehensive planned visit in September 2015. This inspection checked our 16 key lines of enquiry. Key questions safe and effective were rated ‘requires improvement’. Overall the location was rated ‘requires improvement’. Breaches of Regulation 18 (staffing) and 19 (fit and proper persons) were found and we issued two requirements. An action plan was received by us in September 2015. A previous inspection in 2013 and two previous inspections in 2012 were compliant with the outcomes we inspected.

This visit was the second comprehensive inspection under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the second rating under the Care Act 2014. We found the breaches of Regulation 18 and 19 from our September 2015 were compliant. The rating has improved to ‘good’ overall. Key question safe remains at ‘requires improvement’, as further work is required with regards to medicines management and the prevention and control of Legionella. We have made some recommendations throughout our report.

People were safeguarded from abuse and neglect. There was a robust system in place to ensure that people’s safety was maintained.

Risks for people were assessed, mitigated, documented and reviewed. Appropriate records were kept and readily available to demonstrate this to us at the inspection.

The building and premises risks were assessed and managed to ensure people, staff and visitor safety at all times. The service did not have a Legionella risk assessment at the time of the inspection, but obtained one shortly afterwards. There are actions required by the provider arising from the findings of the risk assessment.

Enough staff were deployed to support people. Care workers we spoke with were satisfied that there was sufficient staff and that they did not place people at risk when they were busy. Our observations showed that the service was busy at times, but overall calm and relaxed and staff were dedicated to the people they supported.

Medicines were not always safely managed. We examined the handling of people’s medicines during our inspection and found that people were at risk of medicines incidents.

Staff were knowledgeable and competent. They received improved levels of training, supervision and performance appraisal.

The service followed the requirements of the Mental Capacity Act 2005 (MCA). The recording of consent and best interest decision meant the service complied with the MCA Codes of Practice. There was clear information at the service regarding people’s applications, reviews and expiry dates for standard DoLS authorisations.

We found the service was caring. We observed staff were warm and friendly. As staff had worked with most people over an extended period of time, they had come to know each person well. Many of the people who used the service had lived there for long periods of time. This reflected in the care that people received from staff.

Personalisation of bedrooms was evident. External agencies we spoke with provided positive feedback about the service. We found people had the right to choose or refuse care or activities and this was respected by staff. People led the life they chose to and this was not changed by anyone at the service. We saw people’s privacy and dignity was respected at all times.

Responsive care was provided to people. Their wishes, preferences, likes and dislikes were considered and accommodated. Staff knew about the complaints procedure and people had the ability to complain. People did not always know about the complaints process, but told us they had no hesitations to raise concerns if needed.

The workplace culture at White Lodge Care Home was good. Staff described a positive place to work and care for people. Staff told us they enjoyed their roles and found management approachable and reasonable. Sufficient audits of the service were conducted to check the quality of the care.

Initial assessments were undertaken to ensure people's needs and preferences were clearly identified. Care plans were developed to inform staff members on how to deliver care according to needs identified and risk assessments were conducted to manage identified risks. One relative said: 'They know all of X's idiosyncrasies and if I want to know anything about X they look it up in the care plan.'

People were provided with nutritious meals and drinks. Care plans guided staff members on how to support people to have a nutritious balanced meal. This was to ensure people were not at risk of poor nutrition and dehydration.

On the day of our inspection the lift engineer was in attendance servicing the lifts. We looked at record of checks carried out by the engineer and saw no issues were found and the equipment was in working order. This showed equipment was properly maintained and suitable for its purpose.

There were enough qualified, skilled and experienced staff to meet people's needs. One staff member told us they had enough time to carry out support to people and thought the shifts were well managed. This was supported by one relative who told us: 'There is not much of a turnover in staff, there is very good continuity of care.'

The home had systems in place to ensure the equipment was maintained and fit for purpose.

Appropriate recruitment checks were carried out before new staff commenced work.

People told us they would raise concerns with the home's manager if needed. People's complaints were investigated and resolved, where possible, to their satisfaction.