Archived: Pathfields Lodge

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.

People’s experience of using this service.

Checks and records made during recruitment processes were insufficient and did not evidence that staff were safe to work with vulnerable people.

People were exposed to the risk of harm in a number of areas around the building.

Systems of governance and oversight were not sufficiently robust to have identified the issues we found in relation to recruitment and environmental safety.

Care plans were not well-organised and did not always contain accurate or up to date information. This made it difficult to find important details about people’s needs.

In line with the Mental Capacity Act, 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.

The service didn’t always (consistently) apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support due to a lack of choice and control and limited inclusion in care planning.

People and relatives were happy with the service they received. We were told.”I’d be very happy to recommend Pathfields to anyone looking for a nursing home for their family,” and "I have nothing but praise for my relative's carers.”

People, relatives and staff spoke positively about the registered manager and felt able to raise concerns and were confident that these would be addressed.

Staff received varied training to enable them to carry out their roles effectively.

Staff enjoyed working at the service and felt supported by each other and the registered manager. We were told, ”It’s a good team,” and “[Manager] is very supportive.”

When there were complaints or concerns, the registered manager dealt with them appropriately and put measures in place to reduce the likelihood of recurrence.

The registered manager recognised the importance of retaining staff and was keen to improve the service and promote good practice.

Rating at last inspection. Rated good, report published 3 November 2016.

Why we inspected:. This was a scheduled inspection based on the rating at the last inspection

Enforcement. At this inspection, we found the service to be in breach of three regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.

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.

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

The inspection took place on 16 September 2016 and it was unannounced, further documentation to complete the inspection was received from the provider on 20 September 2016.

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.

People were protected from the risks of abuse. Staff understood what constituted abuse and the safeguarding procedures to follow to report abuse both internally and externally. People were supported to express their autonomy and make informed choices when taking risks.

Staff were employed following safe and robust recruitment procedures. There was sufficient numbers of suitable staff to meet people's assessed needs. Staff received appropriate training to ensure they were equipped with the right skills and knowledge to support people using the service. Staff supervision systems ensured that staff had regular supervision meetings to reflect on their work practice and plan their learning and development needs.

Suitable systems were in place to safely manage medicines. Medication risk assessments took into account people's capabilities to manage their own medicines and when staff needed to take on the responsibility. Regular medicines audits ensured that any areas for improvement were identified and action was taken to address them.

People's consent was sought before staff provided their care. People who lacked capacity to make decisions were supported following the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People had a balanced and varied diet and their dietary needs were assessed and monitored. They had regular access to healthcare professionals and were supported to attend health appointments to ensure their health and well-being needs were met.

Staff treated people with kindness, compassion, dignity and respect. Independence was promoted and people were enabled to make and maintain relationships. Individualised care plans were in place that reflected people's needs and choices on how they wanted their care and support to be provided.

People and their representatives were encouraged to provide feedback on the service and their views were listened to and acted upon. Suitable arrangements were in place to receive and respond to complaints.

The vision and values of the service were person-centred. People and their representatives were supported to be involved and in control of their care.

Suitable governance and quality assurance management systems were in place to monitor all aspects of the service provision.