Lighthouse Lodge

We found the following examples of good practice.

• The service followed up to date guidance regarding safe visiting procedures. Visits were restricted to essential visitors only if there was an outbreak of COVID-19 within the home. However, there were safe measures in place to facilitate visits for people receiving end of life care and where it had been assessed as being in the person’s best interest due to their wellbeing.

• Temperature and testing checks were completed on all visitors.

• There was a dedicated procedure to mitigate the risk of the spread of infection should people catch COVID-19 or show symptoms.

• Safe procedures for admitting people to the service were followed with people only admitted to the home after a negative COVID-19 test.

• Stocks of the right standard of personal protective equipment (PPE) were well maintained and staff used and disposed of it correctly.

• People and staff had access to regular testing.

• Guidance on the use of PPE and current IPC procedures were clearly visible across the service.

• Staff reassured people throughout the pandemic and provided them with the support they needed to maintain regular contact with their family and friends through the use of technology. For example, emails and relatives meetings that were held electronically.

Lighthouse Lodge is a care home that provides accommodation for up to 80 people who need help with their personal care. At the time of the inspection 44 people lived in the home. Some of the people living in the home, lived with dementia.

People's experience of using this service

Medication management was unsafe. Some people’s medicines were not given safely in accordance with the manufacturer’s instructions. Staff lacked clear guidance on how to administer people’s ‘as and when’ required medicines. Records in relation to the administration of thickening medication (prescribed to prevent people from choking) were not properly maintained and some of the medicines within the home could not be accounted for.

Some of the risks to people’s health and well-being were not monitored properly. Information on some people’s emotional well-being was not accurately recorded to enable staff to offer appropriate support. People’s bowel health was not accurately recorded to enable staff to assess and monitor for further complications. This placed people at risk of inappropriate and unsafe care.

The systems in place to monitor the quality and safety of the service were not always used effectively to identify and mitigate risks. This meant the service was not always well-led.

Staff recruitment was managed well and the number of staff on duty was sufficient to meet people’s needs. Staff spoken with were knowledgeable about the day to day support people needed. They knew their personalities and preferences and spoke with genuine warmth about the people they cared for. Feedback from people and their relatives was positive.

The home was safe, clean and well maintained. Infection control arrangements were in place to prevent and mitigate the risk of COVID-19. Appropriate protective and personal equipment (PPE) was in place and care staff used this appropriately. Catering staff were reminded during the inspection, that the use of a facemask, was required at all times when in the kitchen.

The manager knew the service well. During our inspection, they were open and transparent. The culture of the service was positive and the atmosphere relaxed and homely. It was clear the manager was passionate about the service and committed to continuous improvement. However, the lack of reliable and effective quality assurance meant that service delivery risks had not been picked up and addressed to ensure people always received good care.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 24 October 2020). The service remains rated requires improvement.

Why we inspected:

The inspection was prompted in part due to concerns received about medicines, people’s care and the management of the home. 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 COVID-19 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 not changed and remains requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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 monitor the service.

We have identified breaches in relation to Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of medication and risk management and Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of good governance.

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

Follow up:

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

Lighthouse Lodge is a care home that provides accommodation for up to 80 people who need help with their personal care. At the time of the inspection 48 people lived in the home. Some of the people living in the home, lived with dementia.

People's experience of using this service:

At the last inspection, the provider was rated requires improvement with a breach of regulation 17 of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, with regard to record keeping. At this inspection, although care plans and risk assessments had improved this work was still ongoing. Enough improvement had been made however for the provider to no longer be in breach of regulation 17.

People’s risks were assessed but, information in some people’s care files was sometimes contradictory. Information on people’s medical conditions and the signs and symptoms to spot in the event of ill-health was very limited and required improvement.

Medicines were managed safely with people’s ability to manage their own medication positively supported. Some people required their drinks to be thickened with a thickening agent to prevent them from choking. Records relating to this were not always clear. The competency of staff to administer medicines also needed to be re-assessed. We spoke with the manager and the regional manager about this and both of these issues were acted upon without delay.

People’s daily records showed that they received the care and support identified in their care plan. People looked well looked after, relaxed and comfortable in the company of staff.

Staff recruitment was managed well. Staff spoken with were knowledgeable about people’s needs and the people they were caring for.

The home was safe, well maintained and clean. Infection control arrangements were in place to prevent and mitigate the risk of Coronavirus. Appropriate personal protective equipment (PPE) was place and staff were using this appropriately in the day to day delivery of care.

The systems in place to monitor the quality and safety of the service had improved since our last inspection. They were being used effectively to make improvements to the service. Since our last inspection, a new manager and regional manager had come into post and during our inspection they were approachable, open to feedback and committed to continuous improvement.

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 January 2020). At their last inspection we identified a breach of regulations 17 (Good governance). After the inspection, the provider completed an action plan to show us what they would do and by when, to improve. At this inspection, the provider had achieved the improvements identified in their action plan.

Why we inspected

This was a planned focused 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 reinspection programme. If we receive any concerning information we may inspect sooner.

Lighthouse Lodge is a residential care home providing personal care to 47 people at the time of the inspection. The service is registered to support up to 80 people in one adapted building. The home is located over four floors.

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

Staff knew people well and included them in decisions about their care preferences. However, care plans were not always completed to reflect the person-centred care being given to people.

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 and the policies and systems in the service supported this practice. However, mental capacity assessments were not always completed in line with legislation and it was not always clear what decisions were being assessed. DoLS had been applied for appropriately to keep people safe, however one care plan contained inaccurate information with regard to this. We found no evidence people had been restricted of their freedom unlawfully.

Due to the large volume of new staff recruited in the home, and with an issue with the induction process, not all staff had completed induction training. The registered manager had put measures in place to ensure staff were safe and competent to carry out their role and had arranged for extra induction training sessions to take place before the end of the year. The induction process had been changed recently and staff would be able to access training in a more timely way. Clinical training for nursing staff was up to date and it was clear there was a continuous drive to seek out further training to ensure clinical practice was kept up to date.

Audits and checks were completed by the registered manager; however, these were not always effective at identifying concerns. We made a recommendation about this. The registered manager was responsive to our feedback during the inspection.

The home was clean and well maintained and the environment was pleasant. However, on one floor the decoration of the environment had not been fully considered for those living with dementia. We made a recommendation about this.

Risks to people were assessed and appropriate plans were in place to keep people safe. There were clinical governance procedures in place which ensured risks to people were identified and addressed in a timely way. Checks on the environment and most equipment were completed to ensure they were safe to use. However, we found pressure relieving mattresses had not been checked regularly, and checks had not been recorded. We made a recommendation about this.

Most staff had been recruited safely. However, two records we looked at did not include a full employment history and not all gaps in employment had been accounted for. We made a recommendation about this.

There were enough staff to meet people's needs. We saw people had good relationships with the staff that supported them. People were treated with dignity and respect. Staff supported people to be as independent as possible and express their views about the service and their care. Some relatives felt there had been a reduction in staff numbers since the home first opened, but the registered manager explained the home had been staffed based on full occupancy from opening which may give the impression staffing had reduced. This had not always been communicated effectively to people and their relatives.

People told us they felt safe living at Lighthouse Lodge and they liked living there. There was a range of activities available for people.

Staff understood their role and had confidence in the registered manager. Staff told us they worked well together as a team, and there was good morale amongst them.

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

Rating at last inspection and update

This service was registered with us on 09/11/2018 and this is the first inspection.

Why we inspected

This was a planned inspection based on our inspection programme for newly registered services.

Enforcement

At this inspection we have identified a breach of regulation in relation to record keeping with regard to people's care and treatment.

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.