Archived: St Paul's Lodge

Updated 28 September 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 22 and 24 July and 12 August 2015 and was unannounced. On the first day one inspector and an expert by experience with experience in dementia care visited the home. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. On the second day one inspector visited. On the third day two inspectors visited the home to gather further evidence.

Before the inspection we reviewed the information we held about the home. This included looking at information we had received about the service and statutory notifications we had received from the home. We also contacted commissioners from the local authority and the local authority safeguarding team.

We usually send the provider a Provider Information Return (PIR) before the inspection. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We did not send a PIR to the provider before this inspection.

We spoke with six people who were living in the home, four relatives, three care staff, the cook, the activity co-ordinator, the manager and the providers. We also spoke with a healthcare professional who was visiting the home during our inspection.

We looked at three people’s care records in detail and others to follow up on specific information, three staff files, medicine records and the training matrix as well as records relating to the management of the service. We looked round the building and saw people’s bedrooms, bathrooms and communal areas.

Updated 28 September 2015

This inspection took place on 22 and 24 July and 12 August 2015 and was unannounced. At the last inspection on 21 and 30 October 2014 we found five breaches in regulations which related to consent, medicines, recruitment, person-centred care and quality assurance. We requested an action plan from the provider detailing how improvements would be made but did not receive one. At this inspection we found some improvements had been made however we identified further breaches in regulation.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

St Paul’s Lodge provides personal care for up to 21 older people living with dementia. There were 19 people using the service on the first day we inspected and 20 people on the second day. Accommodation is provided on three floors, there are single and shared rooms and some have en-suite facilities. There are three communal areas on the ground floor including a dining room.

The home had a registered manager who left on 1 June 2015. A new manager started in post on this date and was present during this 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.

We found although some improvements had been made to medicines management significant concerns remained. We could not be sure some people had received their prescribed medicines as records were incomplete. We found arrangements for the cold storage of medicines were not safe. We found some medicines were being administered by staff who had not received medicine training. We made a safeguarding referral in relation to one person’s medicines, although the issues were addressed by the manager immediately when we brought it to their attention. We found further shortfalls in how medicines were managed when we returned on the third day.

People told us they felt safe. Yet we found risks to people’s health and safety were not appropriately managed, particularly in relation to people identified at risk of falling. We found there were not enough staff to meet people’s needs and keep them safe.

Although staff had been trained and had a good understanding of safeguarding we found issues we identified relating to medicines and weight loss had not been identified as safeguarding or picked up and rectified by the provider or manager. We also found on the third day of our visit that other safeguarding incidents had not been identified or reported.

People told us they enjoyed the food and we saw people could help themselves to drinks throughout the day. However, people who were of a low weight were not always receiving the nutritious type of food and drink they required and there were not adequate systems in place to monitor people’s food and fluid intake or weight.

We found the service was meeting the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards.

Staff told us they received the induction, training and support they needed to carry out their roles although we found records to evidence staff training were incomplete. Staff had a good understanding of people’s needs, yet care records lacked specific detail which put people at risk of receiving inconsistent or unsafe care. We saw people had access to healthcare services such as GPs and district nurses.

There were plenty of activities for people who spent time in the communal areas and we saw people enjoyed playing games, singing and watching DVDs. However, for people who choose to stay in their rooms there was a lack of activity provision.

We saw people had good relationships with the staff and the manager led by example checking with people to make sure they were okay and overseeing the care being delivered. People generally spoke highly of the staff and we observed some kind and caring interactions. However, some relatives raised issues about the lack of privacy and respect. People knew how to make a complaint and we saw complaints were dealt with appropriately.

We found the new manager had brought about improvements in the service, which was confirmed in feedback we received from relatives, staff and a district nurse who visited the home regularly. They told us the home was now cleaner, people looked smarter and better cared for and the manager was ‘on top’ of things. We found the manager had a good understanding of the improvements that needed to be made. They had already started to address some issues such as arranging training updates for staff and arranging for contractors to visit to make improvements to the environment. However, when we returned on the third day we identified further concerns which reduced our confidence in the assurances the manager had provided.

Overall we found significant shortfalls in the care and service provided to people as well as the continued lack of robust quality assurance systems, which had been identified as an issue at the last inspection in October 2014. We found that issues we identified during the visit had not been picked up by the provider or manager.

We identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment (including medicines), good governance, safeguarding, nutrition, staffing and person-centred care. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. Following our inspection the local authority reviewed its position regarding its commissioning arrangements with the home. The provider worked with the local authority to move people to alternative accommodation.