Mostyn Lodge Residential Home

Mostyn Lodge Residential Home is a residential care home providing personal care without nursing for up to 16 people. The service provides support to older people who often have dementia. At the time of our inspection there were 16 people using the service.

The home is an adapted building where each person has an individual bedroom and there are shared facilities. There is access for all to lounges, the kitchen and the garden.

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

People were comfortable in the presence of staff and were able to tell us they felt safe. However, systems to keep them safe from potential abuse were either not being followed or were ineffective. Information was not shared with external bodies such as the Care Quality Commission (CQC) or the local authority.

Some risks and ways to mitigate them were assessed in line with best practice, such as pressure care and use of hoists. However, there were areas where care plans lacked guidance for staff around other risks. For example, supporting people who could become distressed or upset and eating and drinking.

People had individual medicine administration records which included their preference of how to support them. However, concerns were found with other areas of medicine management placing other people at risk of potential harm. Some of these were rectified by the management during the inspection.

People and their relatives felt staffing had recently got better at the home and records demonstrated this. Although, there were feelings that care staff were stretched by having to work in the kitchen as well. Recruitment systems were in place although improvements were required in some of the checks being completed.

Systems were not always in place or effective to manage the service. The management had a wealth of audits they completed. However, concerns identified on the inspection had not always been found within these. The provider’s policies and procedures were not always being followed.

People, relatives and staff were incredibly positive about the manager and the support they provided. Although, differing approaches at management level led to inconsistencies.

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 good (published 27 August 2021).

Why we inspected

The inspection was prompted in part due to concerns received about medicine management, infection control, staffing and safety of people living in the home. As a result, we undertook a focused inspection to review the questions of safe and well-led only.

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 see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to medicine management, risk assessment, keeping people safe from potential safeguarding and systems to manage the service.

Please see the action we have told the provider to take at the end of this report.

We have also made two recommendations in relation to recruitment and the duty of candour.

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 or assess the home.

Mostyn Lodge Residential Home is a residential care home providing personal and nursing care to 10 people aged 65 and over at the time of the inspection. The service can support up to 16 people.

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

People were happy and settled at Mostyn Lodge. We observed people to be comfortable and relaxed with staff, interactions between people and members of staff were warm and friendly. Both people and their relatives were positive about the care at the service. Relatives were confident their loved ones were safe and received the care and support they needed. Staff had been recruited safely and received regular training. The environment was clean throughout; both people living at the service and their relatives commented favourably about the standards of hygiene.

The provider had systems in place to manage and assess the quality and effectiveness of the service. Currently there was no registered manager in post but suitable arrangements were in place for the day to day running of the service. People and their relatives told us the service was well-run and they felt able to raise any concerns or make requests for changes to care and support. Staff told us they felt supported and that the team worked well together. Staff at the service worked with a range of professionals to manage people’s health needs. The provider had systems in place to monitor the service and took action when shortfalls were identified.

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.

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 good (published 12 February 2020).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding and staffing. A decision was made for us to inspect and examine those risks.

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.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mostyn Lodge Residential Home on our website at www.cqc.org.uk.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Mostyn Lodge Residential Home is a converted former domestic property providing accommodation across two floors. On the ground floor there are two lounges, the dining area, kitchen and bedrooms. A conservatory provides level access to the garden. The first floor is accessible by stairs and a chairlift, where there are further bedrooms. Communal bath, shower and toilet facilitates are available on both the ground and first floors.

We found the following examples of good practice.

Visitors were greeted on arrival at the front entrance to the home, where guidance was displayed. Visitors were required to have their temperature checked, complete a health declaration, clean their hands and then supported to put on the personal protective equipment (PPE) provided. This included, aprons, masks, gloves and for some visitors, face visors too.

People's relatives were supported to visit the home. A designated room was available for visits which was adjacent to the main entrance. For those people who were unable to access the visiting room, visitors were supported to see them in their bedrooms. The provider had identified other entry points to the building in order to reduce footfall throughout the home. However, the provider was not advising visitors of the latest government guidance in relation to physical contact during visits. This was rectified following the inspection by the management of the home.

People appeared relaxed and comfortable in the presence of staff who were all wearing appropriate personal protective equipment (PPE).

People and staff were tested in line with national guidance for care homes. People and staff had been supported to receive the first COVID-19 vaccinations.

A cleaner, along with day and night staff were completing the cleaning at the home. Cleaning schedules did not consistently inform staff where to clean or what to use to clean. Touch points, such as light switches, had not been specified as areas that needed more frequent cleaning. This was rectified following the inspection by the management of the home.

Mostyn Lodge Residential Home is a residential care home and was providing personal care to 15 people aged 65 and over at the time of the inspection. The service can support up to 16 people.

Mostyn Lodge Residential Home is a converted former domestic property providing accommodation across two floors. To the ground floor there are two lounges, the dining area, kitchen and bedrooms. A conservatory provides level access to the garden. The first floor is accessible by stairs and a chairlift, where there are further bedrooms. Communal bath, shower and toilet facilitates are available on both the ground and first floors. The registered manager’s office is located on the third floor.

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

The provider had made improvements and the service was now well-led. There was a programme of quality audits in place and these were used effectively to identify shortfalls. Staff and relatives confirmed there was a person-centred culture in the home. The provider had built relationships with local organisations and engaged with people, staff and relatives.

People told us they were supported by staff who were kind. People’s dignity and privacy was respected by staff. The provider supported people to express their views and worked to ensure people’s equality characteristics were met.

The provider had made improvements since our last inspection and these changes meant people now received safe care. The provider assessed potential risks and provided guidance for staff about how to lower risks to people. People were protected from potential abuse because staff knew what to do if abuse was suspected or witnessed. Medicines management had improved since the last inspection and medicines were now managed safely. The provider used a staffing assessment tool to review the needs of people, and staff were deployed and maintained in line with the assessed levels. However, we received mixed comments about staffing levels in the home. The provider learned lessons when things went wrong.

People received care that was responsive and their communication needs were met. People were supported to maintain relationships that were important to them and provided with a programme of meaningful activities. The provider had received one formal complaint since out last inspection and was working with the complainant to resolve the issue.

The provider had made improvements since out last inspection and these changes meant people received care that was effective. Assessments of people’s needs were person-centred and the provider was working to make healthcare assessments more person-centred. Staff received training relevant to their roles. People were supported to eat and drink and risks in relation to food and drink were assessed. The provider worked with professionals to achieve good outcomes for people. The home was clean and free from unpleasant smells.

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.

Rating at last inspection and update: The last rating for this service was requires improvement (published 22 January 2019) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

We carried out this inspection after we received concerns in relation to a lack of statutory notifications and information received from other health and social care organisations. As a result, we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk. We inspected the service against three of the five questions we ask about services: is the service well led, effective and safe?

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity, so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Mostyn Lodge Residential Home 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 is registered to provide care and support for up to 16 older people, living with dementia and/or physical disability. To the ground floor there are two lounges, one with a conservatory overlooking the garden that is accessible to people and contains raised flower beds. There is a communal dining room and walk-in bath/shower room.

There were 14 people living in the service at the time of our inspection

There was not a registered manager for the service. 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. A manager was in place and had applied to the Commission for their registration.

Radiators throughout the home were not covered, this meant that people were at risk of burns from potentially hot surfaces. Work to fit radiator covers commenced during our inspection, however when we contacted the provider after the inspection we were told that not all the work to cover the radiators had been completed.

The service did not consistently submit statutory notifications to the Commission. Registered providers must notify us about certain changes, events and incidents that affect their service or the people who use it.

The service did not consistently recruit staff safely. In one staff file we identified that a person who had disclosed a criminal conviction had been employed by the service without a photograph ID or risk assessment. This meant that people were not always protected from potential abuse

Audits did not consistently identify shortfalls and when issues were identified corrective actions were not always taken. For example, the lack of radiator covers and incomplete staff induction records, care records and recruitment files.

The service maintained safe levels of staff. The manager used a staffing dependency tool and this calculated staffing levels required according to peoples’ individual needs, including the level of assistance required to use the toilet, mobilise and eat.

The environment was clean and free from malodours. Fixtures and fittings were well-maintained and in good condition.

The service worked with external agencies including opticians, GPs and district nurses. We also saw effective communication and respectful exchanges between staff working at the service.

We identified five breaches of the Health and Social Care Act (Regulations) 2014 and one breach of the Care Quality Commission (Registration Regulations) 2009. You can see what action we told the provider to take at the back of the full version of the report. Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.

Mostyn Lodge Residential Home provides care and accommodation for up to 16 older people. There were 11 people living in the home at the time of our inspection. The provider had recently taken over and was in the process of making extensive improvements to the fabric of the building at the time of our inspection. The previous registered manager left the service in August 2017. A new manager was going through the process of becoming registered. 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.

Relatives told us people were kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service. Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and families were involved in making decisions about their care.

Staff received regular training in topics the provider considered mandatory and were knowledgeable about their roles and responsibilities. Staff received specialist training for some but not all people’s complex health needs; however there were plans in place to address this.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times. Any staff shortages were responded to quickly and appropriately.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.

People received their medicines safely. The manager completed regular checks to ensure medicines were safe. People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring.

Staff told us the provider and manager were accessible and approachable. Staff felt able to speak with them and provided feedback on the service.

The manager, provider and management consultant undertook regular audits and spot checks to review the quality of the service provided and made the necessary improvements to the service.

Mostyn Lodge provides accommodation for people who require personal care to a maximum of 16 people. At the time of our inspection, 14 people were living at the service.

A registered manager was in post 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. On the day of our inspection the registered manager was on annual leave. The deputy manager of the service assisted us throughout the inspection.

The service had not ensured that people were fully protected against the risks associated with medicines. Medicines that had additional legal requirements in relation to the storage, retention, recording and disposal of these medicines were not recorded accurately. The physical balance of these medicines held was inaccurate. People’s individual medicine records were not always accurate and a medicine stored in the service was not fit for consumption. Recruitment was not safe as some Disclosure and Barring Service checks had not been completed as required.

The registered manager had not ensured staff had received appropriate supervision and appraisal. The service understood their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS), however we found that staff knowledge in DoLS was limited. DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. In addition, staff were not fully aware of how the Mental Capacity Act 2005 impacted on their work despite receiving training in the subject.

There were some governance systems to monitor the health, safety and welfare of people. However, the absence of some systems or the failure to use other systems already in place had resulted in the procedural errors and omissions we have identified not being identified by the registered manager. Records were not stored securely and could not be produced when required.

People at the service felt safe and spoke positively about their relationships with staff. People’s relatives and visitors also spoke positively. Staff understood how to respond to suspected and actual abuse. There were sufficient staff on duty to keep people safe and the registered manager and deputy manager supported staff when required. The service was clean and audits of infection control practice were completed. There were emergency plans for people in the event of a fire and the service completed checks of fire safety equipment.

People and their visitors said staff at the service provided effective care. We received positive feedback to support this. Staff received appropriate training to provide a good standard of care and when asked, spoke positively about the frequency and standard of training they received. Staff also had the opportunity to obtain national qualifications with support from the provider. People had access to healthcare professionals where required and supporting records showed that appropriate referrals had been made when needed. People were supported with eating and drinking as required to maintain their health and wellbeing.

People and the visitors we spoke with told us the staff at the service were caring. We received positive feedback about staff and the care provided. We reviewed the compliment cards in the hallway of the service that reflected the views of the people and visitors we spoke with. People’s relatives and visitors were welcomed to the service at any time and we observed good relationships between visitors and staff. Staff understood the people they cared for well and we observed positive interactions during our inspection.

People felt the service was responsive to their care needs and we made observations that supported this. During our review of care records, we saw they contained personalised information and staff used this information to provide person centred care to people. People were allocated a keyworker to support them. The service provided activities for people to partake in, using both external entertainment providers and the staff at the service. The service had a complaints process which people and their relatives felt they could use if needed.

People and their relatives knew the management structure within the service. Staff told us they worked in a supportive environment and that they could approach the management of the service. The registered manager had systems to communicate with staff and quality assurance surveys were being developed.

We found three breaches 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.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity by the staff. People told us that staff treated them well. People were cared for by staff who were aware of the risks to people's safety and health and staff knew how to support them in a safe way.

Systems were in place to make sure that the manager and staff learn from events such as accidents and incidents and complaints. This reduced the risks to people and helped the service to continually improve.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and that their care needs were met. It was clear from observations and from speaking with staff that they had a good understanding of people's care and support needs. Comments included, 'Staff are very kind', and, 'Staff provide good care; they listen to me and do what I ask.' We also spoke with a relative of a person who used the service. The relative told us, 'Staff treat people well' and said they were very happy with the care provided. Staff had received training to meet the needs of the people living in the home.

Is the service caring?

People were supported by kind and respectful staff. We saw that staff showed patience and compassion when supporting people. People told us that they could do the things they enjoyed. Our observations confirmed this. One person told us, 'I've been here six years and wouldn't change anything. Staff provide the care that I need'. Staff told us they were able to provide the care that people needed.

People using the service, their relatives and staff completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

Is the service responsive?

People's needs were reviewed regularly and in response to any changing needs. We saw information in people's records which indicated they had been consulted over the care they received. This meant that information about people's preferences were gathered and used to plan care to meet their specific needs. People were supported to maintain relationships with people that were important to them.

The service worked well with health and social care professionals and services to make sure people received their care in a joined up way.

Is the service well led?

The service had a quality assurance system and records we saw showed that the registered manager monitored people's care needs and the care provided. As a result the quality of the service was continually improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

People told us that they were being asked for their views about the home and the service they received. One person said there were meetings in the home when people could 'air their views'. We found that standards in the home were being checked and audits undertaken as part of a new system for quality assurance. These arrangements helped to ensure that the risk of harm to people was reduced and improvements were made when needed.

Staff told us that they felt well supported in their work. We found that the arrangements being made for supporting staff had improved and there was a more planned approach to training.

However the provider had not taken sufficient action to ensure that all the standards were being met. As we found at the last inspection, there was no effective system in place for monitoring and assessing the quality of service that people received. There were risks to the people who used the service, as relevant guidance and legislation were not always being followed.