Background to this inspection
Updated
9 June 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by one inspector and a specialist nurse advisor. An Expert by Experience contacted relatives of people who use the service via telephone following the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Pathfields Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
The inspection was unannounced; however, we spoke to a member of staff on the phone before entering the service. This supported the home and us to manage any potential risks associated with Covid-19.
Inspection activity started on 8 December 2020 and ended on 9 December 2020.
What we did before the inspection
We reviewed information we had received about the service since the last inspection, such as notifications from the provider and information from the local authority and the public. We used all of this information to plan our inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with ten relatives of people who used the service about their experience of the care provided. We spoke with eight members of staff including the registered manager, the regional manager, a nurse, two care staff, the maintenance officer, the chef and an administration assistant. We also spoke with a visiting speech and language therapist.
We reviewed a range of records. This included six people’s care records and thirty-one people's medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data, maintenance records and survey information.
Updated
9 June 2021
About the service
Pathfields Lodge is a residential care home providing personal and nursing care for up to 48 people. At the time of the inspection 32 people were being supported.
The building is comprised of two wings, Pathfields and Greenfields, each of which have three floors.
People’s experience of using this service and what we found
Improvements were required to assessing and mitigating risks to people. We found concerns regarding risks of scalding and risks to people’s health and safety.
Improvements were required to the environment and the risks this posed. For example, we found several insecticide and rodenticide pods around the communal areas of the home.
Medicines management required improvement. Medicines were not always managed or stored safely.
Systems and processes in place to assess, monitor and improve the service were not effective. Audits completed had not identified the concerns we found during the inspection. When the provider identified issues detailed action plans had not been completed.
People’s privacy had not always been maintained. We found personal information stored in an unlocked office.
Improvements were required with communication between the service and relatives. The provider sent out surveys to allow relatives to feedback on the service. However, not all relatives had received this or felt they had an opportunity to give feedback.
People were protected from Infection. Staff wore appropriate personal protective equipment and the home followed best practice regarding social distancing, shielding and accessing testing for staff and people.
Staff were recruited safely and trained appropriately. The provider completed a dependency tool and updated their rota to ensure enough staff were on duty. However, not all relatives thought there were enough staff on each shift to meet individual needs of people living at Pathfields Lodge.
The provider had systems and processes in place to protect people from abuse.
Relatives and staff knew how to complain. Complaints had been appropriately recorded and managed.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
The service ensured that people can live as full a life as possible and achieve the best possible outcomes by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible to gain new skills and become more independent.
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 requires improvement (published 16 July 2019) and there were breaches of three regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection improvements had been made, however the provider was still in breach of regulations.
Why we inspected
We received concerns in relation to negative interactions between people who use the service, a lack of qualified nursing staff and delays in seeking relevant medical intervention. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
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 coronavirus and other infection outbreaks effectively.
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.
The overall rating for the service has remained as requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pathfields Lodge on our website at www.cqc.org.uk.
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 risk management, maintenance, medicines, controlling infection and management oversight 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.