Archived: Spring Lodge Residential Care Home

Updated 21 January 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 18 and 20 November 2014 and was unannounced.

The inspection team consisted of two inspectors.

Before the inspection, we reviewed all the information we held about the service including previous inspection reports and notifications received by the Care Quality Commission. A notification is when the registered manager tells us about important issues and events which have happened at the service. We also reviewed the Provider Information Return (PIR) submitted by the registered manager. This is a form that asks for some key information about the service, what the service does well and improvements they plan to make. We used this information to help us decide what areas to focus on during inspection.

During the inspection we spoke with three relatives, three people using the service, six members of staff, a GP, a social worker, a visiting chiropodist and the registered manager. We reviewed the care records of four people in detail and the records of two staff. We also reviewed other records relating to the management of the service such as medicines administration records, training records and policies and procedures. Not everyone was able to verbally share with us their experiences of life at the home. This was because of their dementia and complex needs. We therefore spent time observing people in communal areas to understand their experiences.

Updated 21 January 2015

At an inspection on 11 October 2013 we asked the provider to take action to make improvements to care and welfare, staff recruitment and staff training. Following that inspection we also issued a warning notice telling the provider they had to improve quality assurance processes. We carried out a follow up inspection on 17 January 2014 to check compliance with the warning notice and found improvements had been made.

The inspection took place over two days on 18 and 20 November 2014 and was unannounced.

We found that the provider and the registered manager had not taken action to improve care and welfare, staff recruitment and staff training, and were not meeting legal standards. In addition we found the provider and the registered manager had breached nine further regulations, relating to assessing and monitoring quality, safeguarding vulnerable adults, cleanliness and infection control, medicines management, meeting people’s nutritional needs, respecting and involving people in their care, consent to care, staffing levels and notifying the Care Quality Commission of events.

Spring Lodge Residential Care Home provides accommodation and personal care for up to ten older people. The home is situated in a residential area of Worthing close to the sea front. Some people living in the home were living with dementia or a learning disability which meant their ability to understand and communicate their needs and wishes was limited. There were nine people living in the home at the time of our inspection.

A registered manager was 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.

Following our inspection, the registered manager submitted applications to cancel both the registered manager and provider registrations with CQC. These applications are currently under consideration. She also told the local authority of her intention to close the home on 5 December 2014. Social services worked closely with relatives to ensure that everyone using the service was safely transferred to another home.

The registered manager was responsible for care and decision making in the home. The culture of the home was not centred on the needs of people using the service, and care practices were poor. Staff were not supported effectively and there was a lack of governance to improve the quality of care.

People’s care was not delivered safely. Risk assessments in respect of moving and handling were not accurate or up to date and we witnessed moving and handling practice which was unsafe. An urgent referral to social services safeguarding team was made for one person using the service because we were concerned for their care and welfare. People were not protected from abuse. The registered manager had not followed safeguarding guidance when signs of abuse were witnessed.

People’s dignity was not respected. The registered manager had taken actions to control potential behaviours which may challenge without taking professional advice and without putting behaviour management plans in place. Actions included rationing sweets, chocolate, toilet paper, wipes and incontinence pads. People were ‘told off’ if they didn’t ‘behave’ and were spoken about in a way which was derogatory. Some people using the service were unhappy and fearful. There was a set routine in the home about what time people could get up, what they did during the day, what time they ate, what time they got ready for bed and what time they went to bed. People were not free to make their own choices. There were no planned activities, these were on an ad hoc basis when staff had time.

Care planning around the administration of medicines was unsafe and records were difficult to read and were incomplete. There was a risk that people would not receive the right medicines at the right time and staff were not given enough information to administer medicines safely.

The home was dirty. The provider had not employed a cleaner and staff did not have time to complete cleaning tasks in addition to caring for people. The infection control policy did not refer specifically to the home and made no reference to ‘The Health and Social Care Act 2008 Code of Practice on the prevention and control of infections’. This code of practice was not followed in the home, and unsafe procedures were followed in respect of cleaning, laundry, food storage and the disposal of contaminated waste. People using the service were at enhanced risk of infection because of these poor practices.

There was not enough staff on duty at night to keep people safe. Only one member of staff was on duty during the night shift in the home and they were expected to carry out cleaning and laundry duties whilst looking after nine people. This level of staff did not meet people’s needs and was unsafe. Staffing levels were not based on people’s assessed needs.

Recruitment procedures were unsafe as proper checks were not carried out. Two members of staff were working without a full criminal records check. Appropriate references and employment histories were not obtained. During our inspection an attempt was made by the registered manager to fake a reference. The registered manager could not be sure that the staff recruited were suitable for the role.

People using the service were at risk of malnutrition and dehydration. Risk assessments were inaccurate and out of date and suitable actions, in terms of monitoring and seeking professional advice, had not been sought to address the identified risks. One person was identified at risk of choking but the advice of a speech and language therapist had not been sought. This put the person at risk of harm.

Staff had not received sufficient training to carry out their roles. Moving and handling practical training had not been carried out and we saw unsafe moving and handling techniques in the home during our inspection. This unsafe practice put people at risk of harm.

Staff had received training in respect of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards however they did not know or understand the principles of the Act. Mental capacity assessments had not been carried out for anyone using the service where their capacity was in doubt and there were no best interest decisions recorded. There was a risk the home was providing care for people without valid consent. The provider had not made any applications under Deprivation of Liberty Safeguards to restrict their freedom of movement, yet people were not free to leave unsupervised. There was a risk that people were illegally deprived of their liberty.

People’s health needs were not responded to promptly and care plans were not an accurate reflection of people’s current needs and preferences. People were at risk of harm and inappropriate care because their needs were not attended to.