Sovereign Lodge Care Centre

We found the following examples of good practice.

The provider was following current government guidance with regards to visiting in the home. On arrival visitors were asked to complete a COVID-19 questionnaire and a lateral flow device (LFT) test. People’s temperatures were recorded, and Personal Protective Equipment (PPE) was provided for everyone entering the home.

Visits now took place in people’s rooms whenever it was safe to do so. However, people still had the option to use the visiting pod or carry out video calls if they chose to.

Families had been kept updated throughout the pandemic to ensure they were aware of visiting and testing requirements. Relatives had also been informed when an outbreak had occurred at the home. There were safe processes in place for people who chose to go out. People were asked to carry out a LFT on their return and everyone was completing a regular PCR test.

There were dedicated housekeeping staff. The home was seen to be clean and tidy throughout. Cleaning schedules were in place to ensure regular disinfection and cleaning was carried out. Infection Prevention Control (IPC) checks and audits ensured that safe policies and procedures were being maintained.

Staff had received IPC and COVID-19 related training. Staff were observed to be wearing and disposing of PPE appropriately. PPE stations were located around the building to ensure staff had easy access to this equipment.

The registered manager was following safe admission procedures in line with government guidance when new people moved into the home.

A testing regime was in place for all staff in line with government guidance. Results were collated by the registered manager to ensure an audit trail was in place. Staff were aware of the isolation requirements should they test positive.

We found the following examples of good practice.

The registered manager had followed current guidance in relation to infection prevention and control. This included implementing COVID19 cleaning schedules, personal protective equipment (PPE) stations and further training and competency checks for all staff. Guidance was displayed and available for all staff, this included correct procedures for putting on and taking off PPE. As well as environmental risk assessments in relation to COVID19, people and staff had individual COVID19 risk assessments completed. This considered each person’s associated risks, including long term and underlying health conditions, ethnicity and pregnancy.

At the time of the inspection three people were still isolating in their rooms due to testing positive for COVID19. People who had completed their period of isolation were able to access communal areas if they wished. Staff were supporting people to remain safe. Due to people’s dementia and memory loss staff were working to remind people why they needed to socially distance. To support this, the registered manager had made some environmental changes to the communal areas. Seating in the dining areas had been rearranged. This prevented people sitting closer than two metres or in groups.

The home had experienced a high number of positive COVID19 people and staff. Throughout the pandemic staff had monitored people’s physical health, this included their temperatures and general symptoms. The registered manager and staff had shown resilience and had managed the impact of COVID19 extremely well throughout the pandemic. The registered manager felt hopeful and was positive that things would continue to improve. The registered manager had implemented their contingency plan to ensure that staffing levels were maintained whilst high numbers of staff were unwell or isolating and had worked closely with the local authority and market support team.

The home was currently closed to admissions and non-essential visitors. Measures had been implemented to ensure people and staff entering the home did so following current guidance regarding PPE and social distancing. This included temperatures being taken on arrival, Lateral Flow (LFT) COVID19 testing and PPE being used.

Further measures had been implemented to protect staff and mitigate risk. For example, the registered manager had ensured that all staff who had previously used public transport or shared cars to travel to and from work, now had access to taxis, funded by the provider.

Sovereign Lodge Care Centre provides accommodation, nursing and personal care for up to 64 older people. Some people lived at the home whilst others were there for short stays, following discharge from hospital for re-assessment and respite. There were 61 people using the service at the time of inspection.

The service is purpose built and provides accommodation and facilities over three floors. The ground floor provides care for people whose main nursing needs are related to physical health needs. The middle floor provides nursing care for people who are living with a dementia or a mental health need. The top floor is smaller and tends to support people who are more independent but still need a level of personal or nursing care.

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

People and their relatives were positive about the care and support provided at the home. They told us they felt people were safe and comfortable. Staff assessed and responded to any risks and took measures to reduce these and to keep people as safe as possible. Staff understood how to safeguard people against any abuse or discrimination. There were enough staff working to meet people's assessed care and support needs and medicines were managed safely. Checks of the building and equipment were completed regularly by the maintenance person and ensured the environment remained safe.

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.

People at Sovereign Lodge Care Centre received individualised personalised care that responded to their nursing and support needs. People told us all their care needs were met by staff who were skilled and had a good understanding of their needs and how they should be met. People had access to health professionals to promote their health and social well-being.

Staff training was well established and included specialised training to meet people’s specific care needs. For example, dementia care training was provided to all staff whilst the registered nurses completed clinical training which reflected the needs of people in the service. People's dietary needs were assessed, and food provided was tailored to their individual need and they enjoyed it People were supported to eat a range of healthy, freshly cooked meals, drinks and snacks each day.

Staff treated people with respect and kindness and were passionate about providing a quality service that was person centred. It was evident that staff knew people well and strong supportive relationships had been built with people and their families. People's independence, privacy and dignity were promoted.

There was a clear complaints policy and complaints were resolved in a timely way with people satisfied with outcomes. People had choice and control over the activities they wanted to participate in each day. These were an important part of the care and tailored to people's likes and abilities.

The registered manager knew people and staff well and she was held in high regard by both. She had established a full staffing and management team that were working hard to support a quality service. They understood their responsibilities and monitored the standard of care and support provided. She was passionate and committed to delivering a high standard of care to each individual person in the service.

Rating at last inspection and update

The last rating for this service was requires improvement (published 29 November 2018) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

This inspection took place as part of our planned programme of inspections.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection programme. If any concerning information is received, we may inspect sooner.

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

The inspection took place on the 16 October 2018. This visit was unannounced. A second inspection day took place on the 17 October 2018 and was announced.

Sovereign Lodge is situated in Eastbourne and provides accommodation, nursing and personal care for up to 64 older people. Some people lived at the home whilst others were there for short stays, otherwise known as respite. There were 60 people using the service at the time of inspection; 56 living there and four staying for respite.

Sovereign Lodge provided accommodation across three separate floors, each of which had separate adapted facilities. The ground floor provided care to people with mainly physical health needs, while the first floor specialised in providing care to people living with dementia. People that lived on the second floor were more independent and required less support from staff. There were numerous communal areas for people to relax in and a hairdresser on site. There was also ample and well-maintained garden space which we saw people enjoying during inspection.

At our last inspection in August 2017, the service was rated 'Requires Improvement'. During this inspection, we found some areas still required improvement. This is therefore the second inspection where the service has been rated Requires Improvement.

There was not a registered manager at the time of inspection. 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 home manager who had only been at the service for 8 weeks. They had already applied to be the registered manager and were currently going through the registration process with us.

A number of shortfalls were found within record keeping which demonstrated current auditing processes needed to be further developed. Although there was a care plan audit, this had not identified all of the issues we found on inspection. People's support needs were not consistently identified in their care plans, which were hand written and often difficult to read. There were limited assessments with regard to specific support needs, such as diabetes, swallowing difficulties and positive behaviour support. Documentation that was missing or incomplete was not always identified. Staff we spoke with had a thorough knowledge of people and their support needs, which meant where shortfalls were identified, there was limited impact to people. However, there was a potential risk that if unfamiliar or new staff were to read care plans, they would not have all the information they required to support people.

During observations of the lunch-time experience, we found staff were not always responsive to people, particularly if they became anxious or required support with food. Meal-times were task-focused and once staff had served people their meals, there was less interaction. This had already been identified by the home manager, however more improvements were needed to ensure people were always engaged with. For one person, changes in their health had not been responded to effectively or in a timely way.

People told us they felt safe. Staff demonstrated a good knowledge of how to safeguard people and there were suitable numbers of staff to meet people's support needs. Medicines were managed in such a way that people received them safely. Checks of the building and equipment were completed regularly by the maintenance person and ensured the environment remained safe.

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

Staff had received a wide variety of training and people and their relatives were confident that staff had the right skills and knowledge to support people effectively. Staff spoke positively about their induction into the service and said regular supervision was given. People had access to health professionals to promote their health and social well-being. Their nutritional needs were met and they spoke highly about the quality of the food. The building had been adapted to meet the needs of people.

Everyone we spoke to was complimentary of the staff team and described them as, “Kind, caring and passionate.” It was evident that staff knew people well and strong relationships had been built with people and their families. People’s independence, privacy and dignity were promoted.

Staff were knowledgeable of people's communication needs. There was a clear complaints policy and people, relative's and staff knew how to raise concerns. Complaints were resolved in a timely way and people were satisfied with outcomes. People had choice and control over the activities they wanted to participate in each day. These were tailor-made to people's likes and dislikes.

Although improvements were required in people’s documentation, people, relatives and staff spoke highly about the new home manager. They felt that a transparent and supportive culture was promoted and many improvements had already been made. The home manager valued feedback received and used this to improve the lives of people. They were passionate about future plans for the service and encouraged continuous learning to ensure best practice could be achieved.

We found one breach 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 this report.

At the time of this inspection 62 people were living in the service with 24 people on the ground floor 27 people on the first floor and 11 people living on the second floor. This inspection took place on 10 and 11 of August 2017 and was unannounced.

The service had 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. Sovereign Lodge Care Centre was registered under new ownership in May 2016 and this is the first inspection since that change.

The management systems did not always ensure safe and best practice was followed in all areas. The provider could not demonstrate that all medicines were administered in a consistent way and accident reporting did not allow for auditing. Some care records did not ensure clear guidelines were provided for staff to follow. This meant important care instructions may not be passed on to all staff and could impact on the care provided. These areas were identified to the registered manager for improvement.

Staff did not always engage with people on a regular basis. They did not take all opportunities to engage with people in communal areas or in individual rooms in order to prevent the possibility of social isolation and promote person centred care. People were aware of how to make a complaint and felt that they had their views listened to, however complaints were not clearly recorded to confirm that they were used to improve the service. All these areas were identified to the registered manager for improvement.

People were looked after by staff who knew and understood their individual needs well. Staff were kind and treated people with respect, promoted their individuality and independence whenever possible.

Staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Recruitment records showed there were systems which ensured as far as possible staff were suitable and safe to work with people living in the service. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a deprivation of liberty and followed correct procedures to protect people’s rights.

Staff were provided with a full induction and training programme which supported them to meet the needs of people. Staffing arrangements ensured staff worked in such numbers, with the appropriate skills that people's needs could be met in a timely and safe fashion. The registered nurses attended additional training to update and ensure their nursing competency. Medicines were stored, administered and disposed of safely by staff who were suitably trained.

Staff monitored people's nutritional needs and responded to them. Preferences and specific diets were provided. People were supported to take part in a range of activities maintain their own friendships and relationships with whoever they wanted to.

Staff related to people as individuals and took an interest in what was important to them. Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views on a daily basis and satisfaction surveys had been completed. People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be.