Archived: Redcot Lodge Residential Care Home

Redcot Lodge Residential Home is a residential care home providing accommodation and personal care. The service can accommodate up to 18 people in one adapted building. At the time of the inspection there were 16 people living at the service. Some people were living with dementia and some people had learning disabilities.

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

Quality assurance and governance systems were not effective in making sure risks to people’s safety were managed safely. For the past year the registered manager, had not been managing the service on a day to day basis. They had failed to have continuous oversight or scrutiny about what was happening at the service. They had failed to undertake any checks and audits to identify concerns and shortfalls. When they returned to the service on a more regular basis, they had found some of the issues but were unaware of the extent of the shortfalls and concerns we found at this inspection. Concerns identified at the previous inspection had not been prioritised and improvements had not been made and implemented.

People were not protected from the risk of avoidable harm. When concerns were identified about people's safety, information was not shared with appropriate stakeholders so investigations could be conducted. Risks were not managed. The registered manager had not ensured all risks associated with people and the service had been assessed and action had not been taken to make sure risks were mitigated. The registered manager was ensuring that people were protected from the risk of infection.

The registered managers lacked oversight of the incidents and accidents. Lessons had not been learnt when things went wrong.

Medicines were not always managed safely. Handwritten record had not been doubly signed by staff to reduce the risks of errors occurring. Staff did not have guidance for 'when required' medicines that were prescribed for people when they became distressed. Staff could not find any medicines audits to check that medicines had been given safely and any errors identified.

There was not always enough staff on duty to ensure care was delivered in a safe way. Staff received essential training to complete their role, but not all staff received training about people's specific health conditions.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of Safe and Well Led:

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

The model of care and setting did not always maximise people’s choice, control and independence. People were not considered and involved in the planning of their care.

Right care:

Care was not always person-centred and did not always promote people’s dignity, privacy and human rights. People did not always have access to meaningful and person-centred activities.

Right culture:

Ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services lead confident, inclusive and empowered lives.

People were supported with their health needs. GP’s, district nurses and other specialists were contacted when they were needed. Staff were recruited safely. All safety checks had been completed before new staff started working at the service.

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 24 July 2019) and there were breaches of regulation. 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 not been made and the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received from the local authority about lack of care planning and risks associated with people’s care. A decision was made for us to inspect and examine those risks and to follow up on action we told the provider to take at the last 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.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well Led sections of this full report. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Redcot Lodge Residential 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 breaches in relation to safeguarding, risk, medicines, lack of staff, and leadership, management, scrutiny and oversight of the service.

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

Follow up

We met with the registered manager following the inspection to discuss how they will make changes to ensure they improve their rating to at least good. They agreed with that they would not admit any new people to the service until improvements were made.

Following the meeting we were informed that the provider had made the decision to close the service and would be cancelling their registration with the CQC. The registered manager and the local authority were working with people and their relatives to make ensure people were moved safely to other services that were able to meet their needs.

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 until they are de-registered, if we do not propose to cancel the provider's registration. 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.

Redcot Lodge Residential Home is a residential care home providing personal and nursing care to 16 older people at the time of the inspection. Redcot Lodge Residential Home accommodates up to 18 people in one adapted building.

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

People told us they felt safe living at the service, however, potential risks to people’s health and welfare had not been consistently assessed. Staff did not have guidance to mitigate risk and keep people safe with consistent care.

Accidents and incidents had not been consistently recorded and analysed to identify patterns and trends to reduce the risk of them happening again. The registered manager had not recognised when incidents needed to be discussed with the local authority safeguarding team, to assess whether they needed further investigation to make sure people remained safe.

Staff were not always recruited safely, checks on staff character such as references, had not been completed consistently. Staff received essential training to complete their role, but not all staff received training about people’s specific health conditions.

Medicines were not always managed safely. Records of medicines given to people were not always signed. Staff did not have guidance for ‘when required’ medicines to make sure people received their medicines when they needed them.

Care plans were not always completed to reflect the care being given to people. However, staff knew people well and people told us staff supported them in the way they preferred. Some audits had been completed but they did not cover all aspects of the service. The audits completed had not identified the shortfalls found at this 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 support this practice. However, the way best interest decisions had been made had not been recorded.

People met with the registered manager before they moved into service to check staff could meet their needs. People were supported to eat a balanced diet, people had a choice of meals, people’s preferences and dietary needs were catered for.

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. People’s health was monitored, and they were referred to health professionals when required.

There was an open and transparent culture within the service, people and staff were asked for their views and opinions about the service and these were acted on. There had been no formal complaints in the last year, but people told us they knew how to complain.

People’s end of life wishes were discussed and recorded. Staff worked with the GP and district nurses to support people at the end of their life.

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 (6 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. Please see the Safe, Effective, Responsive 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.

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

Enforcement

We have identified breaches in relation to the assessment and management of risks , staff recruitment, medicines management and the general management of the service 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 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.

Redcot Lodge Residential Care Home is in Cliftonville and has close public transport links. The service offers short and long term residential care for up to 18 people over 65 years old some of whom were living with dementia. There is a well-maintained, secure garden at the rear of the premises. On the day of the inspection there were 16 people living at the service.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The day to day running of the service was managed and overseen by the registered manager with the support of a manager and a human resources manager. They were all present during the inspection. The registered manager was the registered provider.

At the last inspection in September 2015, the service was rated ‘Requires Improvement’, there were breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. The provider did not provide sufficient guidance for staff to follow to show how risks to people were reduced. There was no system to analyse accidents and incidents. The provider did not always deploy sufficient numbers of competent, skilled and experienced staff to keep people safe and to meet their needs. Care plans were not updated and reviewed regularly. Quality assurance checks had not been consistently completed. We asked the provider to make improvements. The provider sent CQC a plan of actions to address the shortfalls. At this inspection the actions had been completed and the breaches had been met.

People felt safe living at the service. Staff knew how to respond to abuse and how to keep people safe. People were involved in making decisions about taking risks and staff explained risks to them in a way they could understand. Risks to people were assessed, monitored and reviewed.

Staff knew about abuse and knew what to do if they suspected any incidents of abuse. Staff were aware of the whistle blowing policy and the ability to take concerns to agencies outside of the service.

There were enough staff to meet people’s needs. The registered manager followed the provider’s recruitment process to make sure staff employed were of good character and safe to work with people. Staff completed regular training to keep them up to date with best practice. One to one meetings and annual appraisals were held to discuss their personal development.

People received their medicines safely and on time from staff trained to administer medicines. Medicines were stored, managed and disposed of safely.

Staff knew the importance of giving people choices and gaining people’s consent. Staff understood the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been agreed by the local authority as being required to protect the person from harm. The registered manager and staff understood their responsibilities in relation to DoLS and had completed applications in line with guidance. At the time of the inspection there was no-one living at the service with an authorised DoLS.

People enjoyed a choice of healthy of food and drinks. Snacks were available for people to help themselves to whenever they wanted. People’s health was assessed, monitored and reviewed. Staff worked with health professionals, such as, community nurses and the local hospice to make sure people’s health care needs were met.

People and relatives told us the staff were kind and caring. Staff promoted people’s dignity and treated them and their friends and families with respect. People were encouraged and supported to maintain their independence. People were involved in the planning of their care and support and told us care was provided in the way they chose. Each person had a descriptive care plan which had been written with them and their relatives. Staff knew people’s life histories, likes and dislikes and any preferred routines. People’s choices and preferences for their end of life care were recorded and kept under review. People’s confidentiality was respected and their records were stored securely.

There were no restrictions on visiting times. People were encouraged to keep occupied and activities were provided each day on a group and one to one basis. People told us they enjoyed the activities and enjoyed having barbecues in the garden in the nice weather. A monthly newsletter was given to people and their visitors – this included actions from the last residents meeting, an overview of the previous month and what was happening the next month.

The registered manager encouraged people to feedback on the quality of the service and to share their experiences. People knew how to complain and said they had no complaints or concerns. Regular audits were recorded and included what action was needed, who would take the action and by when.

People, relatives and staff felt the service was well-led. Staff told us they were able to give honest views and felt valued by each other, the registered manager and the organisation. There was a clear and open communication between people, staff and the management team.

There was effective and regular auditing and monitoring. People, relatives and staff were asked their views on the quality of the service provided. The registered manager regularly met with people, their families and staff to encourage them to input into the day to day running and development of the service.

Notifications had been submitted to CQC in line with guidance. The provider had displayed the last report in the entrance area. At the time of the inspection the provider’s website was under construction. The registered manager told us the rating of the report would be displayed, as required by law, when it was live.

We last inspected Redcot Lodge Residential Care Home in September 2015 when breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was identified. At this inspection these breaches had been met and no further breaches were identified.

Everyone we spoke with expressed that they were very happy living at Redcot Lodge. We observed interactions between the people and the staff and also people's reactions to the staff.

People were asked to give consent and were involved in the decisions about the care and support they received. People told us that they were asked for consent before any care took place and their were wishes respected. One person commented, 'Staff know what I can do for myself and help me with the things I can't manage'.

People told us that they had the care and support they needed to remain well and healthy. They said they were involved in decisions about their care and support.

We observed that the provider had provided an environment that was suitably designed and adequately maintained. The home was clean and free from offensive odours.

Staff were supported and supervised to undertake their roles effectively and safely. People told us they thought the staff were very good and knew what they were doing. One person told us, 'The staff are very good'.

Systems were in place to monitor the service that people received to ensure that the service was satisfactory and safe.

Everyone we spoke with expressed that they were happy living at Redcot Lodge. We observed interactions between the people and the staff and people's reactions to the staff. We observed to see how people were.

People told us that they were well looked after, felt safe and would talk to staff if they had a problem. We were told 'I am happy with everything here. My daughter visits me once a month'. Another person said 'The staff are fine and the people are lovely'.

Everyone said that the food was 'good' or 'excellent'.

People told us that the staff 'are very kind' and 'they staff chat to me and have friendly conversations'.

Staff engaged with people in a warm and positive way.