The Lodge

The Lodge is a residential care home providing personal care to up to 38 people. At the time of our inspection there were 33 people using the service. The home accommodates people in one adapted building with private garden access.

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

Risks to people were not always assessed nor their safety monitored. Proper and safe use of medicines was not established. Medicines audits had not identified any of the concerns found during our inspection. The governance framework had not identified the safety concerns found during inspection.

Systems, processes and practices safeguarded people from abuse. Sufficient numbers of suitable staff were employed. People were protected by the prevention and control of infection. Accidents and incidents were monitored. The home had undertaken a programme of substantial refurbishment with more planned.

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 and update

The last rating for this service was requires improvement (published 1 April 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 15 and 18 February 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve assessments of risks, proper and safe management of medicines, and effective systems to assess, monitor and improve the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 not changed and remains requires improvement. This is based on the findings at this inspection.

The last rating for this service was requires improvement (published 2 April 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

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

Enforcement

We have identified breaches in relation to assessment of risk, medicines and management oversight.

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.

The Lodge is a residential care home providing personal care to older people. The service can accommodate up to 38 people. At the time of this inspection, 34 people lived at the service.

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

Risks to people were not always recorded or available within the service to provide staff with sufficient guidance. Medicines were not always administered and recorded appropriately.

Further governance systems were now in place and used to monitor the quality and safety of the service, but they were not yet fully embedded and did not highlight all areas of concern found at this inspection. Timely action had not always been taken to address shortfalls found.

People told us they felt safe living at the service and relatives were happy with the support being provided. Staff described a positive culture within the service and a staff team who were dedicated to their roles.

Safe recruitment processes were in place and followed. A safe number of staff were on duty and deployed effectively to ensure people’s needs were met.

The provider had taken action to respond to the Infection Prevention and Control (IPC) concerns found at the last inspection, and improvements had been made. Government guidance in relation to COVID 19 was now being followed.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 21 May 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced inspection of this service on 1 March 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve how they assessed and recorded risks, staff deployment and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

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 not changed. 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 The Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

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 continued breaches of regulation in relation to risk and medicine management and governance systems at this inspection.

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

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.

The Lodge is a residential care home providing personal care to older people. The service can accommodate up to 38 people. At the time of this inspection, 33 people lived at the service.

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

People were not always safe. Government guidance in relation to infection prevention and control had not always been implemented or followed. Risks to people were not always appropriately managed or recorded. Medicine records did not provide staff with sufficient detail regarding when and how to administer medicines.

There was a lack of effective systems and processes in place to monitor the quality and safety of the service.

Staff had not always been deployed effectively to ensure people received support they required in a timely manner.

Staff had been recruited safely and people told us they felt safe living at the service. Any safeguarding concerns had been appropriately reported. Staff spoke highly of the management team and described an open and honest culture.

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 26 February 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about infection prevention and control and COVID-19 management. A decision was made, in accordance with our inspection methodology, for us to inspect and examine those risks.

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.

We inspected and found there was a concern with risk management, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

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.

The provider took immediate action to address the concerns and shortfalls found during the inspection. They submitted an action plan and provided regular updates to the CQC regarding steps they had taken to ensure the service was safe.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to infection prevention and control, assessing risk, staffing levels and governance at this inspection.

We took urgent enforcement action to ensure infection prevention and control was appropriately managed to reduce the risk to people.

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

People’s experience of using this service: People and their relatives told us that staff had a clear understanding of their needs and considered their preferences. They told us staff had the right skills and knowledge to meet their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; policies and systems supported this practice. Staff knew the importance of offering choices to people and respecting their wishes in line with the values of the service.

People were happy with the range of activities and told us these were centred around their likes and interests. People were supported to access the local community when they wanted to. People received information in a format they could understand and staff supported them to communicate their views and opinions using their preferred methods.

Staff encouraged people to be independent. Interactions between staff and people were pleasant and respected their privacy and dignity. Staff knew how to support people in the last days of their lives in a dignified way to make them as comfortable as possible.

The environment supported choice for people to have time on their own or with other’s. Health and safety checks were in place to ensure people's environment was safe.

Care records were centred around people and their likes and preferences. Staff understood the importance of person-centred care and could explain how they supported people to achieve this.

Systems in place to recruit staff were robust. People told us they felt safe and staff knew how to protect them from avoidable abuse or harm. Risks to people were identified and appropriate measures put in place to avoid repeat incidents such as falls.

Staff felt supported and valued for their contribution to people's lives.

Quality assurance checks were in place to look at the quality of the service and how this could be continuously improved. Management was keen to make positive changes to people's lives and listened to both staff, relatives and people's feedback to drive these improvements.

Rating at last inspection: Good. (Last report published 11 August 2016). This report can be accessed at: https://www.cqc.org.uk/sites/default/files/new_reports/INS2-2473771243.pdf

Why we inspected: The inspection was a scheduled inspection based on the previous rating.

Follow up: 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.

The Lodge provides accommodation for up to 38 older people who require personal care. Nursing care is not provided. Accommodation was provided in a large detached building with two purpose built extensions on the South Cliff area of Scarborough. The building was set in its own grounds and was surrounded by well-maintained gardens. The service was close to shops and close to a bus route. There were 35 people resident on the day of the inspection.

There was a registered manager employed at this service. 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 told us they had confidence in the registered manager and staff said they enjoyed working at the service. Feedback from people who used the service was positive about the service provided. People’s views were sought at residents meetings, staff meetings and through daily conversations.

There was an inclusive culture within this service and it was evident that managers and staff worked as a team to provide people with a good standard of care.

Staff were recruited safely with appropriate checks carried out of their background prior to their appointment. There was sufficient staff on duty to meet people’s needs. They had been trained in safeguarding adults and could tell us how they would recognise and report any abuse.

People lived in a safe, clean and hygienic environment. Staff were supported in maintaining people’s health and safety through the use of clear policies and procedures.

Accidents and incidents were recorded and analysed to identify any trends on a monthly basis.

Medicines were managed safely by staff that had been trained.

Staff were knowledgeable about the people they provided care for and had the necessary skills to meet people’s needs. They received an induction when they started work at the service and were supported by senior staff through supervision and an annual appraisal.

Staff were trained in and worked within the principles of the Mental Capacity Act (MCA) 2005.We saw that where necessary Deprivation of Liberty authorisations were in place.

People’s nutritional needs were recorded in their care plans. Where people developed any problems around eating and drinking support was sought from allied healthcare professionals.

The environment was appropriate for the needs of people who lived at this service. There was a passenger lift to each floor and wide corridors suitable for wheelchairs.

Staff were caring, respectful and friendly towards people. They supported people’s dignity. When people required palliative or end of life care staff worked with clinical nurse specialists to ensure best practice.

Care plans and risk assessments were in place and these were reviewed regularly. They reflected the needs of people but would be enhanced if they were more consistently completed by key workers. Risks to people’s health were identified and there were management plans in place to guide staff.

There were very detailed life histories which contributed to the person centred care people received. Activities were organised at the service regularly and people were able to visit local shops and amenities.

There was a complaints procedure and people knew how to make a complaint. There had been no complaints during the last year.

There was an effective quality assurance system in place with audits carried out to identify any areas where the service could improve. We saw that where any areas for improvement were identified action had been taken or written plans were in place.

Policies and procedures supported the management of the service providing guidance to staff

During the inspection five key questions were answered; is the service safe, effective, caring, responsive and well-led?

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

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

Is the service safe?

Some people told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. One person told us, 'I feel quite safe here. I have not encountered abuse.' Another person told us, 'I would speak with the staff about anything I was concerned about.'

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The registered manager understood the home's responsibilities in respect of Deprivation of Liberty Safeguards (DoLS). They told us there had been no applications in the last twelve months. Following a recent court ruling regarding DoLS in care settings, the provider may wish to review people's living arrangements to check whether their circumstances may amount to a deprivation of liberty according to the revised definition.

We saw the service was safe, clean and hygienic. The home had an effective infection control system. All the staff told us how they worked to prevent infection and how they would manage an outbreak at the home so the risk of infection spreading could be reduced.

Is the service effective?

One relative told us, 'My mother has been so well cared for here. The staff have helped her during the recent changes to her health. The staff have been absolutely wonderful.'

Other people we spoke with told us if they were ill or needed to see a doctor the staff had called one. People told us they regularly saw and had been visited by a range of professionals such as the district nurse and optician.

People explained how their care and welfare needs were met. All people told us they had support with health appointments and felt the service was flexible. One person told us, 'I have a care plan and if I need anything different I just talk to the staff.' Another told us, 'I have lived here a while. The staff always asks me if I want anything.'

Is the service caring?

We saw how staff communicated well with people and were able to explain things in a way which was easily understood. We saw they did not rush people in the home and how the interactions were caring. All the relatives we spoke with said they felt the care was very good. One relative told us, 'I can't fault the staff, they have been very caring.' Another told us, 'All the staff are wonderful. They keep me informed and I visit regularly and see that my mother is very well cared for.'

We saw people were treated with respect and dignity by the staff. We saw people were given choice in their care and all the relatives we spoke to told us they were very happy with the care. All the people we spoke with also told us they were happy with the care and support they received.

Is the service responsive?

All the people told us they were very happy with the service. One told us, 'I have medication that I need to take every now and then. When I need it the staff always help. I just need to ask.'

We saw how staff responded to people's requests for help in a timely way. One person told us, 'I have a buzzer and when I need to I can use it to call for staff and they will help me.'

All the people we spoke with told us they were involved in decisions about their care.

People's care needs had been reviewed at least every month. We saw that when people's requirements had changed the provider had responded and reviewed their care needs so that they could meet their changed support requirements.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service well-led?

We spoke with the registered manager and deputy manager. They showed us there was an effective system to regularly assess the quality of service people received. We found the views and opinions of people using the service and their carers, family and relatives were also regularly recorded.

We saw the home had systems in place to make sure managers and staff learnt from any accidents, complaints, whistleblowing or investigations. This reduces the risks to people and helped the service to continually improve.

Staff also told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure people received a good quality care service at all times.

We found that people were provided with a choice of suitable and nutritious food and drink. People told us they enjoyed the food provided for them. One person said 'No complaints here, they look after me very well.' Another person said 'We always get the best of everything, and the quality of the food is no exception.'

The service was warm and comfortable, and we found that the furniture and d'cor were in keeping with the style of the home. All the areas of the home we looked at were clean and tidy.

There were enough qualified, skilled and experienced staff to meet people's needs and effective management arrangements were in place to provide staff in sufficient numbers to promote people's safety and wellbeing.

People had the opportunity to be able to speak out and raise any issues or concerns that they might have. One person said 'We can ask staff about a little thing and next thing it is sorted.'