Imperial Lodge

Imperial Lodge is a care home which is run by a small private organisation. The provider owns and manages one other care home. One of the owners is also the registered manager for Imperial Lodge. The service provides support to up to 10 people with mental health needs and/or people who have experienced substance misuse. The service aims to help people with recovery and to support people to move on to places where they need less care and support. At the time of our inspection 8 people were using the service.

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

The provider had not always carried out appropriate checks to recruit staff safely, for example, obtaining references from previous employers.

The provider could not demonstrate that new staff received an induction or that staff received regular supervision to be able to support people effectively.

The provider had not ensured there were enough suitably competent and qualified staff to meet the needs of the service. The provider relied on temporary (agency) staff for most shifts. However, there was no evidence agency staff received an induction into the service or training appropriate to the needs of people who used it.

The staff completed online training but had not received specific training in techniques to work with people who had difficulty managing their emotions and anxiety. We did not see any evidence the staff’s competencies were assessed to help ensure they had the skills to undertake their roles.

The provider did not always learn lessons when things went wrong. Although a serious incident had taken place recently, we saw no evidence of meetings or reflective sessions with staff in relation to the incident or any previous incidents.

People’s medicines were managed safely to help ensure people received their medicines as prescribed and in line with national guidance. However, the staff’s competencies to manage medicines were not carried out regularly.

Although the staff undertook some daily safety checks, some checks and audits had not been regular, with most having stopped between June and August 2022.

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’s needs were recorded in their care plans and met. Staff knew people’s needs and how to meet these in line with their care plans.

People told us they felt safe when receiving care and relatives agreed with this. The provider had processes in place for the recording and investigation of complaints and incidents and accidents. Risk assessments contained guidelines and plans for staff on how to minimise risks for people using the service.

The registered manager and senior staff were responsive to and worked in partnership with other agencies to meet people’s needs.

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.

Rating at last inspection

The last rating for this service was good (published 28 March 2018).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk to people’s safety. This inspection examined those risks. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

We found no evidence during this inspection that people were at risk of harm from this concern.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

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 changed from good to requires improvement based on the findings of this inspection. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Imperial Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to staffing, recruitment and governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 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.

• People living at the home were supported to have visitors and the provider ensured appropriate checks were carried out to comply with current guidance.

• Care workers had undertaken infection control training and the use of PPE. We observed care workers were using PPE appropriately and in line with current guidance.

• People were supported to access the community when they wanted and the care workers provided people with information on wearing a mask and social distancing.

• The provider had a clear process for supporting people with monthly COVID-19 testing and ensuring care workers carried out weekly COVID 19 tests in line with guidance.

• The provider had a clear process in place to respond to an outbreak of COVID 19 with people who tested COVID 19 positive being supported to isolate.

• People had COVID 19 risk assessments which identified any issues which could increase their risks and how these could be mitigated. COVID 19 risk assessments were also completed for care workers.

Imperial Lodge is run by a small private organisation. The provider owns and manages one other care home. One of the owners is also the registered manager for Imperial Lodge. 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 16 January 2016 we rated the service Good.

At this comprehensive inspection on the 20 February 2018 we found the service remained Good in all key questions and overall. The inspection was unannounced.

People were happy living at the service. They felt well supported and that their needs were being met. People had been involved with planning their own care and had consented to care and treatment. There was evidence that the provider was meeting people's needs and supporting them with their recovery. The staff worked with other professionals to make sure people's physical and mental healthcare needs were being met.

People lived in a safe environment which was appropriately maintained. There were procedures designed to safeguard them from the risk of abuse. People received their medicines in a safe way and as prescribed. The risks to their wellbeing had been assessed and planned for. People knew how to make a complaint and felt that concerns were responded to their satisfaction.

The staff were kind, caring and supportive. The provider ensured that only suitable staff were employed. There were sufficient numbers of staff and they had the training, support and information they needed to care for people. The staff were happy working at the service and felt well supported.

The owners of the company were involved in the day to day running of the home and one was the registered manager. They worked closely with the staff and other stakeholders to monitor how the service was being delivered. There were effective systems for identifying and mitigating risks, as well as making continuous improvements. People using the service, staff and others were asked for their feedback on the service and their views were listened to and valued.

The last focused inspection was the 20 and 25 August 2015 where we followed up on previous breaches in the Regulations which had been made during the provider's first rated inspection in October 2014 using the new methodology. We found that these breaches had been met. However, we made a new breach of a regulation at this focused inspection relating to the provider not notifying the Care Quality Commission (CQC) of significant events. Since the August 2015 inspection improvements had been made and CQC had been receiving notifications in a timely way.

Imperial Lodge provides accommodation for up to ten people who have mental health and/or substance misuse needs. The service offered different levels of support depending on people’s individual needs. There were eight people living in the service at the time of the inspection.

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 told us that they were happy living in the service. They said the staff were good and the registered manager approachable. Most people were independent but required different levels of support and encouragement. Staff understood people’s individual needs.

Staff supported people in a caring and professional way, respecting their privacy and dignity. We observed staff interacting in a positive way with people offering them daily choices and encouraging them to take part in activities.

People's choices and wishes were respected by staff and people had been involved in reviewing their care. Care plans outlined people’s needs and the support they required.

People had a range of individualised risk assessments in place to help them maintain their independence and to guide staff in how to support them.

People consistently received their medicines safely and as prescribed. Some people were supported to manage their own medicines and this was monitored by staff.

The staff members we spoke with and records we saw confirmed recruitment procedures were being followed.

The provider had acted in accordance with their legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberties Safeguards. They ensured people were given choices and the opportunities to make decisions. People we spoke with confirmed that they had choices in their everyday lives and had consented to the support they received.

Staff told us they were supported through regular meetings with the registered or deputy manager. They received ongoing training and met as a staff team to talk through any issues and to receive updates.

People could choose what they ate and staff were available to provide support and assistance with meals.

The health needs of people were being met. Staff had received support from healthcare professionals and worked together with them to ensure people's individual needs were being monitored and met.

People felt confident to express any concerns and make a complaint, so that these could be addressed. The provider asked people for their views about the service.

There were systems in place to monitor the quality of the care being provided and to make improvements as and when necessary.

People told us the service was excellent. One person said "the staff support us to be independent", another said "the staff are very pleasant and friendly".

People confirmed they were treated with dignity and respect and were supported with their day to day living. We reviewed four care plans and found that people received care and support that met their assessed needs. We found that people had been fully involved in decisions about the way their care was delivered.

People were protected from abuse and staff had a clear understanding of the procedure to take if there were any suspicions of abuse.

Staff members were well trained and given adequate support to carry out their roles effectively.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

People told us that they were happy with the service and support they received at the home. One person said, 'I like it here, we are free to go out, all we need to do is to communicate with staff'.

People confirmed that they were treated with respect and were supported to make choices. They could choose food shopping and how they liked to spend their time and they were free to watch TV in their rooms or in the shared living room.

People told us that they felt safe and protected and they were aware of how to make a complaint if they needed to and they told us that they felt listened to by staff.

We found that people that people were protected from abuse and staff were able to demonstrate their knowledge of safeguarding and what action they would take if they had concerns about the welfare of people they were providing care for.

However the provider did not have systems in place to assess and monitor the quality of service provision. For example the provider had not developed policies on the frequency of reviewing peoples care plans and getting feedback on the quality of services that were provided to people.