Archived: Lily Wharf Lodge

Lily Wharf Lodge is a residential care home, providing accommodation and nursing care for up to 80 older people living with a dementia, and/or a physical disability and younger adults. There were 22 people living in the service at the time of the inspection. The service is purpose built over two floors which is split into four separate units, with communal facilities on each. Both ground floor units were occupied at the time of the inspection.

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

People told us they felt safe and staff understood what action to take if abuse was suspected. Not all incidents and accidents were dealt with in a timely manner. The manager and regional manager took immediate action to ensure these were investigated and acted upon. We made a recommendation about this. Environmental checks and servicing were taking place. There was a very high use of agency staff in the service. Staff told us they needed more permanent staff, but agency staff were being used. Most agency staff told us they had worked in the service previously. We made a recommendation about this. Staff were recruited safely. The service had addressed medicines issues from the last inspection.

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. There was some evidence of consent recorded in care records. Staff confirmed people were asked for permission before undertaking any activity. The service spacious and all bedrooms were ensuite. Staff training was ongoing, the regional manager told us of their plans to ensure all staff were fully trained working in the service. People’s healthcare needs were reviewed by professionals, and we saw people attending clinic appointments during the inspection. There was evidence of assessments being undertaken for most people. However, one person’s assessment had not been completed on arrival to the service. The manager told us this had been done as soon as possible as there was a login error with the computer. They told us the staff had access to relevant information to look after people effectively.

Electronic care records had been developed, the provider was aware improvements were required in their content and reviews and were taking action to address this. Systems were in place to deal with complaints, we discussed the progress of an ongoing complaint. Aids were available to support communication; pictorial aids were used in some areas. Activities were on offer however, one person fed back they used to undertake exercise, but this had not been taking place recently.

People were positive about the care they received. We noted mostly kind interactions. The management took action to ensure one person’s privacy and dignity was respected. We made a recommendation about this. Electronic records as well as paper records were held securely. People’s choices were being discussed and agreed. The manager took immediate action to ensure all people had access to their call bells at all times.

The manager who was new to post left the service soon after the inspection. The regional manager told us they were based in the service and recruitment was ongoing for a new registered manager. A range of audits and monitoring was taking place. Whilst some actions had been recorded not all were noted. Observations, daily walk arounds and night checks were noted. There was some evidence of the actions taken in the form of ‘you said, we did’ on display. A range of policies and guidance was available and statutory notifications were submitted.

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 on 20 October 2021. We found breaches in relation to the training and supervision of the staff team, infection prevention and control and, good governance. 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 remained in breach of regulations.

At our last inspection we also recommended about the management of complaints and concerns, maintaining a balanced diet, the management of medicines, staff recruitment and support, assessments and care planning.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 and Recommendations

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 breaches in relation to ensuring systems or processes were monitored and ensure the service had consistent management in place to ensure the service was safe and monitored at this inspection.

We have made recommendations in relation to ensuring incidents and accidents were acted on appropriately in a timely manner. And to ensuring sufficient and suitable staff were recruited to work in the service, strengthening the medicines audit processes to check medicines records are completed correctly so that people receive their medicines safely as prescribed. And to ensure people received care in accordance with their needs, promoting privacy and dignity and good governance.

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.

Lily Wharf Lodge is a residential care home, providing accommodation and care for up to 80 older people who maybe living with a dementia, and/or a physical disability and younger adults. There were 18 people living in the service at the time of the inspection. The service is purpose built over two floors which is split into four separate units with communal facilities on each.

We found the following examples of good practice.

The home facilitated face to face visits, in line with government guidance. The manager told us this was essential to help support people's psychological and emotional well-being. Alternatives to in-person visitation, such as virtual visits, were also supported.

A ‘booking in’ procedure was in place for all types of visitors to the home including, a health questionnaire and evidence of a negative lateral flow test. This helped prevent visitors spreading infection on entering the premises.

People and staff were tested regularly for COVID-19. Staff employed at the home had been vaccinated, to help keep people safe from the risk of infection.

Infection control policies and audits were in place to ensure the home reflected best practice and current guidance.

Cleaning schedules and audits were in place to help maintain cleanliness and minimise the spread of infection. However, some parts of the home needed to be effectively cleaned.

Staff were trained and competent in infection prevention and control best practices and how to put on and take off PPE. However, during the visit we observed were not consistently following the correct use of PPE such as face masks. This included not wearing masks or pulling then down when talking. We signposted the service to the local Infection Prevention and Control at the local authority for additional support and guidance.

The home had adequate supplies of appropriate PPE.

The manager maintained links with external health professionals to enable people to receive the care and intervention they needed. Virtual consultations took place as and when necessary.

Lily Wharf Lodge is a residential care home, providing accommodation and care for up to 80 older people who maybe living with a dementia, and/or a physical disability and younger adults. There was 10 people living in the service at the time of day one of the inspection and nine people on day two. The service is purpose built over two floors which is split into four separate units with communal facilities on each. Three of the four units were in use at the time of the inspection.

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

We have made a recommendation about; management of complaints and concerns, maintaining a balanced diet, the management of medicines, staff recruitment and support, assessments and care planning.

Staff were observed not wearing masks appropriately and a contingency plan to manage the COVID-19 outbreak was out of date. Significant gaps in the infection prevention and control and donning and doffing training was identified. A range of infection control policies were in place. Recruitment was ongoing, duty rotas confirmed the numbers of staff in the service were sufficient to meet the needs of the people they were supporting. Not all recruitment checks had been completed appropriately. Systems were in place to enable abuse allegations to be investigated. Internal policies and Local Authority guidance was available to support decisions in acting on allegations of abuse.

Individual risks had not been consistently managed safely, and records did not always confirm the actions taken as a result of incidents and accidents. Systems were yet to be implemented to ensure lessons were learnt. Environmental checks had been completed and emergency equipment was in place. Medicines were stored securely and the administration of medicines were provided in a kind and caring manner. Systems were required to ensure regular checks of medicines and learning for any medicines issues.

Staff told us, and records confirmed that there were gaps in the training, induction and supervisions. On the whole people had been reviewed by professionals, most relatives we spoke with confirmed this.

A range of food choices were available to people, and we observed a positive mealtime experience. We saw not all information in relation to people’s dietary input and weights were recorded in line with their needs.

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. Consent agreements had been obtained and where relevant Capacity assessments and Deprivation of Liberty applications had been submitted to the assessing authority

People told us staff provided them with good care. People were treated with respect and we observed kind interactions between people and staff. A range of activities were on offer in the service and people were seen taking part in activities during the inspection. People were supported to communicate.

Care records were in place however these had not always been completed in full. Some would have benefited from more detailed information, and more regular reviews of people’s care records was required. Relatives of people in receipt of end of life care were complimentary about the care they received. Records to support and guide staff in end of life care had not been completed in full. Complaints policies and guidance was in place. We saw one complaint that had not been included in the complaint file.

There was a new manager in post at the time of the inspection. On the whole people were positive about the new manager however, some concerns were raised in relation to communicating with the manager, the senior team and obtaining information and feedback from the service to support investigations in a timely manner. There were delays in obtaining information we requested from the service to support the inspection process and not all information was provided by them.

Some audits and monitoring had been undertaken by the providers regional team however, not all actions had been updated. We had not been informed of all of the safeguarding allegations and this had not been picked up by the providers auditing processes.

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 24 June 2020 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the management of medicines, the management of risks and people’s safety. A decision was made for us to inspect and examine those risks. This was also the services first rating since their registration.

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

The provider has commenced action to address the findings from the inspection. 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 the training and supervision of the staff team, infection prevention and control and, 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 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.

We will request an action plan for 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.