Higher Park Lodge

Higher Park Lodge is a ‘care home’ which provides accommodation and personal care for up to 34 people who may be living with dementia. At the time of the inspection 30 people were using the service. The home is a large-detached property within Devonport Park, Plymouth.

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

People who lived in the service told us they were happy and safe. One person said; “Very happy and safe” and another said; “Carers are very good.” A relative said; “He (named their relative) is very safe living here.”

People looked relaxed, happy and comfortable with staff supporting them. Staff were caring and spent time chatting with people as they moved around the service.

The environment was safe, regularly updated and there was equipment available to support staff in providing safe care and support. Health and safety checks of the environment and equipment were in place.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Records were accessible and up to date. Medicines were ordered, stored and disposed of safely.

Staff received appropriate training and support to enable them to carry out their role safely, including fire safety and dementia care training. Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for people to have social interaction and go out into the community. Staff knew how to keep people safe from harm.

Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection.

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.

Records of people's care were individualised and reflected each person’s needs and preferences. Risks were identified, and staff had guidance to help them support people to reduce the risk of avoidable harm.

People’s communication needs were identified, and where they wanted, people had end of life wishes explored and recorded.

People and staff told us the registered manager and the management team made themselves available and assisted them daily. They went onto say how they were approachable and listened when any concerns or ideas were raised.

People and their families were provided with information about how to make a complaint and details of the complaint’s procedure were displayed at the service.

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 11 July 2017).

Why we inspected

We were prompted to carry out this inspection due to concerns we received about the service, care provider and staffing.

A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. 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 good. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe, Responsive and Well led sections of this full report.

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.

Follow up

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;

The provider was following best practice guidance in terms of ensuring visitors to the home did not spread Covid-19. All visitors were asked to provide proof of a negative lateral flow test (LFT) before entering the home. A booking system was in place to monitor visits and to ensure everyone remained safe.

Where possible staff encouraged people to keep a safe distance from each other and there was additional cleaning of touch points in communal areas to mitigate the risk of cross infection.

The provider ensured enough stock of appropriate Personal Protective Equipment (PPE) was available for people, staff and visitors. There was clear signage around the home about the correct guidance for donning, doffing and disposal of PPE.

Staff were adhering to PPE guidance. There was a plentiful supply of PPE at all PPE stations close to people’s bedrooms.

The providers recruitment process and contingency planning helped ensure staffing levels remained safe in the event of a COVID-19 outbreak in the service.

Policies, procedures and risk assessments relating to COVID-19 were up to date. This meant staff had correct and up to date information to keep people safe.

The service kept in contact with family members through social media, emails and phone calls.

Staff continued to support people to access healthcare and arrangements were in place should people need to attend hospital and return to the home safely.

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

People and/or their relatives told us they felt safe living at the service. Staff were aware of what action to take should they suspect someone was being abused, mistreated or neglected.

Risks associated with people’s health and social care needs were confidently known by staff, and risk assessments were in place to help ensure safe and consistent care was provided to people. However, one person’s care plan and their related risk assessment had not been updated following a change in their needs. Therefore, the registered manager took immediate action at the time of our inspection.

Policies and procedures were in place to keep people safe, and people lived in a safe and clean environment. Staff received training in specific subjects to ensure people’s ongoing safety and wellbeing.

Staff told us they enjoyed working at the service and explained how the registered manager and management team were in attendance at the service, providing support and guidance as necessary. Staff were confident to report any worries or concerns and explained action would always be taken.

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 11 July 2018).

Why we inspected

We received concerns in relation to the safety of people, the cleanliness of the service, staffing, and the management, leadership and culture of the service. In addition, the police were undertaking an investigation into an incident that had occurred at the service. At the time of this report, the investigation had not yet concluded. As a result, we undertook a focused 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. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from the concerns raised. The registered manager had acted to mitigate ongoing risks where needed. Please see the Safe and Well-led sections of this full report.

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

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.

This inspection took place on 14 June 2018. The inspection was unannounced. At the last inspection on 3 April 2017, the service was rated as Requires Improvement as we found not all records were up to date and the governance procedures in place at the time of that inspection had not recognised this. The provider took action and at this inspection we found there had been changes to ensure all records were well maintained and an accurate reflection of people’s care. Systems had been established to double check audits and reduce the likelihood of this occurring again. We found the service had improved from “Requires Improvement” to “Good”, with the caring domain rated as “Outstanding”.

Why the service is rated as Good:

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.

People and their relatives told us staff were exceptionally dedicated, caring and kind. Staff demonstrated compassion for people through their conversations and interactions. They did special things which made people feel they mattered. Feedback about the caring nature and acts of kindness were excellent. Comments included, “So kind and helpful during my auntie’s stay, she still talks about you now”; “I’m glad they found Higher Park Lodge as it is so lovely here”; “Wonderful”; “Wishes happen” and “Staff treat mum and her visitors extremely well.”

We observed staff treating people as individuals with different needs and preferences. Staff understood that people’s diversity was important and something which needed to be upheld and valued. Examples were given to demonstrate how staff respected people’s different disabilities, sexual, cultural and faith needs.

People told us their privacy and dignity was promoted. People all said they were actively involved in making choices and decisions about how they wanted to live their lives. People were protected from abuse because staff understood what action to take if they were concerned someone was being abused or mistreated.

People received care which was responsive to their needs. People and their relatives were encouraged to be part of the assessment and care planning process. This helped to ensure the care being provided met people’s individual needs and preferences. Support plans were very personalised and guided staff to help people in the way they liked.

Risks associated with people’s care and living environment were effectively managed to ensure people’s freedom was promoted. People were supported by consistent staff to help meet their needs in the way they preferred. People’s independence was encouraged and staff helped people feel valued by encouraging their skills and involving them in decisions. The registered manager and provider wanted to ensure the right staff were employed, so recruitment practices were safe and ensured that checks had been undertaken. People’s medicines were safely managed and given to them on time.

People received care from staff who had undertaken training to be able to meet their unique needs. People’s human rights were protected because the registered manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards.

People’s nutritional needs were met because staff followed people’s support plans to make sure people were eating and drinking enough and potential risks were known. People were supported to access health care professionals to maintain their health and wellbeing.

People were cared for in a service which was well maintained and invested in. The home was kept clean and smelled fresh. People were protected from the spread of infection, because safe practices were in place to minimise any associated risks. There was a range of activities which people enjoyed to help keep them stimulated and occupied.

Policies and procedures across the service were in place and available for people in different formats when required. People were treated equally and fairly. Staff adapted their communication methods dependent upon people’s needs, for example using simple questions and information for people with cognitive difficulties and information about the service was available in larger print for those people with visual impairments.

The service was very well led by the registered manager and provider and supported by a dedicated team. There were quality assurance systems in place to help assess the ongoing quality of the service, and to help identify any areas which might require improvement. Complaints and incidents were learned from to ensure improvement. The registered manager and provider promoted the ethos of honesty and admitted when things had gone wrong. The service kept abreast of changes in research to improve care, legislation and kept up to date with health and social care news for example the new data protection laws and the accessible information standard.

We undertook a further unannounced, focused inspection of this service on 10 and 11 August 2016 to check improvements had been made. We found action had been taken to improve many areas, however, there remained problems with the management of medicines. The rating at this inspection remained Requires Improvement. We asked the provider to take action to make improvements, and this action has been completed. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Higher Park Lodge on our website at www.cqc.org.uk.

We undertook this unannounced comprehensive inspection of the 3 and 4 April 2017 The first day of the inspection was unannounced.

The service provides care and accommodation for up to 34 older people, some of whom are living with dementia or who may have physical or sensory health needs. On the days of the inspection 33 people were living at the service.

Accommodation and facilities at Higher Park Lodge are over three floors, with access to the lower and upper floors via stairs or a passenger lift. There are some shared bathrooms, shower facilities and toilets. Communal areas include a lounge, a reminiscence room, a dining room and an outside patio area.

The service had 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 this inspection we found there had been great improvement in most areas, but we continued to have concerns regarding the timeliness of care plans being completed for some people and staff understanding how to use the new assessments in place. We also had concerns that the auditing processes in place had not identified the problems with records we found. The provider took action during the inspection period to address this.

A registered manager was employed to manage the service; they were also the registered provider. 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.

There was a positive culture within the service. The registered manager had clear values about how they wished the service to be provided and these values were shared by the whole staff team.

There was a management structure in the service which provided clear lines of responsibility and accountability. A registered manager was in post that had overall responsibility for the service. They were supported by other senior staff that had designated management responsibilities. People told us they knew who to speak to in the office and any changes or concerns were dealt with swiftly and efficiently.

Feedback received by the service and outcomes from audits were used to aid learning and drive improvement across the service. The manager and staff monitored the quality of the service by regularly by undertaking a range of regular audits and speaking with people to ensure they were happy with the service they received. People and their relatives told us the management team were approachable and included them in discussions about their care and the running of the service.

People told us they felt safe using the service. There were risk assessments in place to help reduce any risks related to people’s care and support needs. Staff had received training in how to recognise and report abuse and were confident any allegations would be taken seriously and investigated to help ensure people were protected.

There were sufficient numbers of suitably qualified staff to meet the needs of people who used the service. The recruitment process of new staff was robust. People received support from staff that knew them well and had the knowledge and skills to meet their needs. People and their relatives spoke highly of the staff and the support provided. There was good supervision processes in place to support staff.

Medicines were administered safely. A new electronic medicine system had been introduced since the previous inspection.

The registered manager and staff had attended training on the Mental Capacity Act 2005 (MCA). Capacity assessments were integrated into people’s care plans and staff asked people’s consent before providing care.

We undertook this focused inspection on the 10 and 11 August 2016.We undertook this focused inspection to confirm that they now met legal requirements. The first day of the inspection was unannounced. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Higher Park Lodge on our website at www.cqc.org.uk.

The service provides care and accommodation for up to 34 older people, some of whom are living with dementia or who may have physical or sensory health needs. On the days of the inspection 32 people were living at the service.

Accommodation and facilities at Higher Park Lodge are over three floors, with access to the lower and upper floors via stairs or a passenger lift. There are some shared bathrooms, shower facilities and toilets. Communal areas include a lounge, a reminiscence room, a dining room and an outside patio area.

The service had 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 this inspection we found there had been substantial improvement in most areas, but we continued to have concerns that medicines were not managed safely.

People’s medicines were not always managed, administered and stored safely. We found changes had been made but these required embedding and further improvement. We found the temperature recordings of the fridge were noted as out of range but action had not been taken which meant medicines may not be effective. A new fridge was to be imminently installed. We found handwritten entries were not always signed by two people and there was not always evidence of GP instruction when alterations had been made. We found people’s care plans gave more information about their medicines and allergies but these were not on people’s medicine records (MARs). This could put people at risk. Body maps were now in place to record people’s skin creams but these required more detail to reflect people’s prescriptions. Instructions for administering medicines were not always followed, this meant people might experience side effects from the medicine or they may not be as effective. We found improvement had been made to recording people’s medicines but this didn’t always match the stock of medicine. The provider told us a new electronic medicine system was being implemented in September 2016 which would address some of these issues.

Staff had updated care plans and a new care planning system was in the process of being implemented. Staff training had improved knowledge on how to develop care plans which reflected people’s risks and care needs. For example how to manage people’s diabetes, skin care and continence needs. People’s new care records were more personalised, detailed and thorough. Care records gave staff guidance on people’s needs and how to care for them, including their end of life care. The recording of care was also much improved for example, food and fluid charts where there were concerns, and repositioning charts where people were at risk of skin damage.

People’s individual risk assessments were also much better and informed staff how to care for people who had nutritional, mobility or skin care needs.

Staff had received trained in the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS) and had greater understanding of how the laws protect people’s human rights. When people did not have the mental capacity to make decisions about their care and treatment, assessments were evident. There was improved guidance in place for staff about how to support people to make decisions. We also observed staff asking for people’s consent before providing personal care and in all conversations throughout the inspection.

Leadership and governance of the service had improved. The service had worked collaboratively with the local authority improvement team, implemented new audits and the registered manager was monitoring the quality of service provision closely. The registered manager had started attending forums where best practice was discussed and had signed up to a local leadership course.

People’s health needs were met and health professionals we spoke with were very positive about the service people received. People could access their GP and other health professionals as required and staff sought advice and recording of advice had improved.

The service provides care for and accommodation for 34 people who are living with dementia or who may have physical or mental health needs. On the days of the inspection 33 people were living at the care home.

Higher Park Lodge is on three floors, with access to the lower and upper floors via stairs or a passenger lift. There are some shared bathrooms, shower facilities and toilets. Communal areas include a lounge, a reading room, a dining room and an outside patio area.

The service had 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 the last inspection on 27 and 29 May 2015, we asked the provider to take action to make improvements as we found care was not always safe, personalised and consistent; people’s privacy was not always respected; people’s consent was not always obtained prior to care being given; risk assessments did not always reflect people’s needs; there was no proper and safe management of medicines; effective systems were not in place to take action should an allegation of abuse be received; staff did not always have the knowledge, experience and skills to support people; and the systems in place to monitor the quality of the service were ineffective. The provider sent us a plan detailing the improvements which would be made to meet the legal requirements in relation to the breaches. The provider told us they would make improvements by the beginning of October 2015.

At this inspection we found some improvements had been made, but we continued to have concerns in several areas.

Prior to the inspection we received information of concern about the service. These included concerns about people’s care; care not being given as people chose; lack of care planning in respect of people’s specific needs and staff not accurately recording people’s day to day care. We reviewed these concerns, along with the issues raised at the previous inspection, during this inspection.

People’s medicines were not always managed and administered safely. Some people told us they were not always observed taking their medicines and we found staff were signing the person’s medicine administration records (MARs) without staff knowing people had safely taken their medicine. There were gaps in people’s MARs so it could not be guaranteed people had been given their medicine as prescribed. Staff were not always clearly recording people had their prescribed creams applied as directed. Storage of medicines was not always safe and we found discrepancies in other records concerning how people’s medicines were given.

People’s care records were not always personalised and did not always show whether people were involved in writing them. However, these were being improved during the inspection. People did not always receive their personal care as they wanted it delivered. The records of people’s care were not always complete and lacked essential details to ensure care given was appropriate and as desired by the person. People’s end of life needs were not always planned with them and the care planning was inconsistent.

People’s individual risk assessments were not reviewed regularly to ensure they reflected people’s current risk. People were not involved in planning how to mitigate the risks they faced while living at the service. People’s care plans and records did not reflect risks which had been identified.

People were not always being assessed in line with the Mental Capacity Act 2005 (MCA). Not all staff had been trained in the MCA and the associated Deprivation of Liberty Safeguards (DoLS). When people did not have the mental capacity to make decisions about their care and treatment, assessments were not always evident and there was a lack of guidance in place for staff about how to support people to make decisions. However, we observed staff asking for people’s consent before providing personal care.

Good leadership and governance was not always evident. The provider had developed new audits but not all of these were effective and had not identified the issues raised during the inspection. However, the provider was working in collaboration with external services to improve the quality of care.

There were some activities and outings which occurred at the home which people who liked participating, enjoyed.

Staff were recruited safely. Staff were receiving training and updates to meet people’s needs. Staff had received safeguarding training and understood how to identify abuse and keep people safe from harm. However, staff did not always understand what was being asked of them. For example new daily checklists had been developed which were being completed but staff were not recognising where there were problems, for example mattresses were not always set correctly to people’s weight but signed as checked. Staff had also worked hard to update care plans but we found they lacked the knowledge to develop care plans which reflected people’s risks and care needs, for example how to manage people’s diabetes, falls or weight loss.

People’s health needs were met. People could access their GP and other health professionals as required. People received a healthy diet but where people required their food and drink intake to be monitored or their weight monitoring, the recording of this was not always accurate. This meant it was not possible to know if people had been eating and drinking enough to maintain their health.

There was a complaints policy in place. People’s concerns were dealt with when they arose. People felt comfortable speaking to the registered manager if they had any concerns. People, staff and visitors felt they could speak to the registered manager and they were approachable.

The service was clean and infection control procedures were followed by staff.

There were systems in place to maintain the equipment and utilities at the service.

The service was working collaboratively with external agencies to improve the quality of care people received.

We found a number of breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.

Everyone we spoke with felt well cared for at Higher Park Lodge. We spoke with staff who knew people well, were well trained and responded to their needs with compassion. We saw evidence of a range of health professionals being involved in people's care and staff seeking advice when needed.

People told us the food is "Nice" and "The food is good and there is enough." We met with the chef and saw home-made meat pie on the day of our visit. The kitchen was well stocked, fresh ingredients were delivered three times a week and people had a good choice of food at each meal. Special diets were catered for and people were prompted to eat where this was needed.

We met with staff who were happy in their roles, felt supported by the management team and were well trained. Staff had completed training in safeguarding vulnerable adults and there were policies in place at the home for staff to follow. These helped staff to feel confident recognising and protecting people from abuse.

We saw a range of measures in place which monitored the quality of care people received at the home and assessed possible risks at the home such as annual resident surveys and regular resident and staff meetings held at the home.

People told us they were happy. One person said 'I'm very happy here.' People told us they were happy with the care and support they received. We observed that staff treated people who had dementia with respect and protected their dignity.

Staff knocked on people's doors and asked for permission to enter. People were supported at meal times and their independence was promoted.

People were able to make choices. We saw that staff respected people's wishes and people told us they felt respected.

We toured the home with the manager and looked at all areas of the home including bathrooms, toilets, bedrooms and communal areas. Overall the home was clean and had made improvements.

The home had completed all required pre-employment checks on staff including references and Criminal Records Bureau (CRB) checks. Records were locked away securely and policies and procedures were in place that gave guidance on their safe storage and disposal.

We saw that the home maintained appropriate and accurate medical and staff records.