The Care Quality Commission
  • Care Home
  • Care home

Archived: St Paul's Lodge

Overall: Inadequate read more about inspection ratings

2 St Paul's Road, Shipley, West Yorkshire, BD18 3EP (01274) 593940

Provided and run by:
Just Global Ltd

All Inspections

22 and 24 July and 12 August 2015

During an inspection looking at part of the service

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.

21 & 30 October 2014

During a routine inspection

St Paul’s Lodge is registered to provide care and accommodation to a maximum of 21 older people living with dementia. We inspected St Paul’s Lodge on 21 and 30 October 2014. There were eighteen people living at the home at the time of the inspection. The first visit was unannounced and the second announced as we had to clarify and seek further information from the registered manager. Our last inspection took place in March 2014 and at that time we found the home was meeting the regulations we looked at.

There was a registered manager in post. 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 systems and processes to keep people safe were inadequate. For example, we found the staff recruitment and selection procedures had not been followed and people had been allowed to start work before all the relevant checks had been made.

We also found medicines were not managed safely, for example, one person did not start a course of prescribed antibiotics until four days after they had been prescribed.

We saw people had access to a range of NHS services and the input of other healthcare professionals, such as district nurses, GPs and chiropodists was recorded in people’s care plans. However, in one person’s records we saw there had been a delay of four days in contacting the person’s GP about an issue which required medical attention.

People who used the service and their relatives told us the care staff were kind and caring and tried hard to create a warm and relaxed atmosphere. People also told us they enjoyed participating in the activities organised by the activities coordinator and were complimentary about the quality of the meals provided.

We saw the complaints procedure was on display within the home and people who were able told us they knew how to make a complaint. They told us they felt the manager and staff would take their concerns seriously and act accordingly.

However, we found the quality assurance systems were inadequate as many of the shortfalls highlighted in the body of this report relating to people’s health, well-being and safety had not been identified by the providers as areas that required improvement.

We also found the service was not meeting the requirements of the Deprivation of Liberty Safeguards. This legislation is used to protect people who might not be able to make informed decisions on their own.

We found five breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 come into force on 1 April 2015. They replace the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

 

25 March 2014

During an inspection looking at part of the service

When we inspected the service in December 2013 we were concerned care and treatment was not always planned and delivered in a way that ensured people's safety and welfare. In addition, we were not confident the provider had an effective quality assurance monitoring system in place which involved people who used the service and/or their relatives.

On this inspection we found the provider had taken steps to ensure people's care and treatment was more person centred and there was now an effective quality assurance monitoring system in place which took into account the views and opinions of people who used the service, their relatives and staff.

On the 21 January 2014 we served a fixed penalty notice to Just Global Limited for failing to have a registered manager in place at St Paul's Lodge. A fine of '4,000 was paid. We are taking further action with regard to this and will report the details when it is complete.

12 December 2013

During an inspection looking at part of the service

The inspection was carried out to follow up the enforcement action we had taken in June 2013 and because we had recently received additional concerns about peoples care and welfare.

We had taken enforcement action in June 2013 because we were concerned people who used the service were not protected against the risks of receiving inappropriate or unsafe care. This was because the care documentation we looked at did not provide staff with up to date and accurate information. We also had concerns about the absence of effective systems to control the spread of health care associated infections. On this inspection we found the provider now had effective systems in place to assess the risk of and to prevent, detect and control the spread of health care associated infection.

However, we were still concerned the people who used the service were not protected against the risks of receiving inappropriate or unsafe care. This was because staff were not always acting in their best interest. We also found there was no effective quality assurance monitoring system in place.

We spoke with the relative of one person who used the service. They told us they had no concerns about the care provided and said "The manager always sends me a text if there are any changes to my relatives health and the home is always clean and tidy when I visit.'

4 June 2013

During an inspection looking at part of the service

The inspection was carried out to follow up a warning notice and compliance actions we issued in February 2013. We had taken this action because we had concerns people were not protected against the risks of receiving inappropriate or unsafe care. We also had concerns about the safety of the environment and the absence of effective systems to control the spread of health care associated infections.

We used a number of different methods to help us understand the experiences of people who used the service. This was because the majority of the people who used the service had complex needs which meant they were not able to tell us their experiences.

We spoke with the relatives of one person who used the service. They told us the care provided to their relative was 'beyond the call of duty.' They said they could not speak highly enough of the staff, their relative was very well looked after and they were kept fully informed and involved.

However, we found the people who used the service were still not protected against the risks of receiving inappropriate or unsafe care because their risk assessments and care/support plans did not provide an accurate and complete record of their needs. We also found the provider did not have effective systems in place to assess the risk of and to prevent, detect and control the spread of health care associated infection.

12 February 2013

During an inspection in response to concerns

We carried out this inspection because we had received information of concern. The information related to the standard of care people who used the service received at the home and the environment. We also followed up a compliance action we made in November 2012 relating to the management of medicines.

We used a number of different methods to help us understand the experiences of people who used the service. This was because the majority of the people who used the service had complex needs which meant they were not able to tell us their experiences. For example, we spent time observing care practices and talking to staff.

At the last inspection in November 2012 the relatives we spoke with told us they had no concerns about the standard of care provided at the home. They told us they always found the staff to be professional in their approach to providing care and support.

However, on this inspection while we found the system for recording and administering controlled drugs had been improved we found the provider did not have effective systems in place to assess the risk of and to prevent, detect and control the spread of health care associated infection.

We also found people who used the service were not protected against the risks of receiving inappropriate or unsafe care because staff did not treat people as individuals and their assessments and care/support plans did not provide an accurate and complete record of their needs.

23 November 2012

During a routine inspection

We used a number of different methods to help us understand the experiences of people who used the service. This was because the majority of the people who used the service had complex needs which meant they were not able to tell us their experiences. For example, we spent time observing care practices and talking to people's relatives and staff.

The relatives we spoke with told us they had no concerns at all about the standard of care provided at the home and always found the staff to be professional in their approach to providing care and support. One person said 'I visit several times a week, I am always made to feel very welcome and staff always find time to answer any questions I might have.' Another person said 'My relative is very happy living at St Paul's Lodge and I feel confident that people are well cared for.'

The staff we spoke with told us there were clear lines of communication and accountability within the home and they were supported through a planned programme of supervision, appraisals and training.

4 May 2011

During an inspection in response to concerns

Due to their complex needs people using the service were not able to tell us about their experiences. We visited the home on 4 May 2011 at 06:00. We found six people were up and dressed in the lounge areas and the staff were in the process of getting two more people up. We did not find any evidence in people's care plans to show that this was in their best interests.