Archived: The Lodge Care Home

The Lodge Care Home is a residential care home providing personal and nursing care to up to 40 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 26 people using the service.

The Lodge Care Home accommodates people in one purpose-built building across 2 floors. Each floor has communal areas and kitchen facilities.

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

Medicines were not always safely managed, protocols for ‘as and when’ medicines were not consistent with prescribers instructions. Storage was not secured, temperatures of storage areas was not consistently monitored and action had not been taken where temperatures were higher than medicine manufactures guidance. Medicine records were not always completed. Medicine disposal bins were overflowing and refuse bags were tied to medicine trollies. People at risk of choking were sometimes left without support when drinking fluids. Hygiene practices did not always promote safety .

Quality assurance systems were not always effective. Actions taken in response to audits had not always improved practice. Audits had not always identified issues such as high temperatures in the medicine room and storage areas not being secured.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; Restrictive ‘bucket’ chairs prevented people from standing up, and we observed one person required assistance from 2 staff to stand from a bucket chair. The policies and systems in the service did not support this practice.

There were enough staff to meet people’s needs, however feedback we received about staffing levels was mixed. Staff were recruited safely. People were protected from the risk of abuse by trained staff. Staff were caring and knew people well. Staff spoke positively about the manager and told us the manager had taken action in response to concerns they had raised. The provider worked in partnership with other organisations.

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

The last rating for this service was requires improvement (Published 01 November 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last 2 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 we found the provider had made improvements, however they remained in breach of regulation 17 good governance.

Why we inspected

We previously carried out an unannounced focused inspection of this service on 13 September 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 remained requires improvement. This is based on the findings at this inspection.

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.

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

Enforcement and Recommendations

We have identified breaches in relation to governance systems and medicines management. 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The Lodge Care Home is a residential care home providing personal and nursing care to up to 40 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 33 people using the service.

The Lodge Care Home accommodates people in one purpose-built building across two floors. Each floor has communal areas and kitchen facilities.

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

Care plans did not always provide enough information to guide staff when a risk had been identified, the provider and manager had also identified this and were continuing to work to action plans they had in place. People were protected from the risk of abuse, safeguarding incidents had been correctly, reported and investigated. The provider had increased staffing levels following our previous inspection and the manager demonstrated how they monitored and adjusted staffing levels appropriately to ensure the staffing levels continued to reflect the needs of the people using the service. Medicines were managed safely, and we were assured that the provider had sufficient infection, prevention and control measures in place.

The provider and manager had made improvements since our last inspection and had an action plan in place which identified areas for improvement. We reviewed the progress of the action plan and could see progress had been made in several areas, however progress in other areas was not on track such as the review and updating of people’s care plans.

We found systems and processes to ensure people’s pressure relieving mattresses were on the correct setting were not robust and there had been a delay in introducing new and improved menus. People spoke positively about the manager and when people suggested improvements to the service, we found these had been actioned.

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 and update

The last rating for this service was inadequate (published 7 March 2022). 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, however we found the provider remained in breach of regulation 17 good governance.

This service has been in Special Measures since 26 January 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We previously carried out an unannounced comprehensive inspection of this service on 11 and 15 November 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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.

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 inadequate to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lodge Care Home 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 monitor the service and will take further action if needed. We have identified a breach in relation to regulation 17 good governance 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

The Lodge Care Home is a residential care home providing personal and nursing care to 36 people aged 65 and over at the time of the inspection. The service can support up to 40 people. Accommodation was provided in a purpose-built home across two floors, with communal areas on each floor.

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

The service lacked provider and management oversight. Audits had not been completed to consider how to mitigate risk or to drive improvements. Where actions had been recorded, these had not been followed up to ensure they had been completed successfully. The provider had not ensured good oversight of the home in maintaining people’s care and safety. There was no registered manager and the deputy and clinical lead were not supported in how to manage the home. Staff and people’s views were not always taken into account to drive further improvements.

The provider had not always worked with partners to maintain the environment, leaving some areas of the home at risk of not being repaired to meet best practice or regulations. Fire regulations had not been maintained and this placed some people at risk in the event of emergency evacuation.

Risks to people were not always assessed and actions taken to mitigate the impact of those risks. There were not enough staff to support people’s needs or the domestic arrangements to ensure hygiene standards. Training was not in place for all areas to support the staff in their role. Safeguarding concerns were not always reported and there was a lack of consideration of how to protect people from harm.

Infection prevention and control was not always well managed. Some areas of the environment required attention to ensure it was kept clean and in good repair. Medication was managed safely.

Care plans were not always up to date and did not always contain important information about people’s life choices and ongoing care. Where people displayed behaviours which challenged, there were no consistent care plans or guidance for staff to manage a difficult situation.

We found some areas were people’s dignity was compromised and this had not been recognised.

Staff were kind and committed to providing good care, however felt restricted by the lack of support, training and provider support.

People enjoyed the meals, however when people lost weight, measures had not been taken to consider monitoring or offering them alternatives. Activities were provided; however, people who chose to stay in their room were not always included or offered alternative activities. When the activities staff were not available there were less opportunities for people.

People’s healthcare had been monitored and referrals had been made to the required professionals to support health conditions. Good partnerships had been established with health and social care professionals.

Complaints had been responded to by the provider, however some relatives felt they had not always been listened to or their concerns had been addressed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support 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

This service was registered with us on 21 September 2020 and this is the first inspection. The last rating for the service under the previous provider was Good, (published on 12 March 2019). The service has deteriorated and is rated Inadequate.

Why we inspected

The inspection was prompted in part due to concerns received about staffing and the provider’s oversight. 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.

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 safe care, staffing and staff training, safeguarding, dignity for people, support with decision making and good governance at this inspection.

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

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.