Archived: Lincoln Lodge Residential Home for the Elderly

The accommodation is over four floors which are served by a passenger lift. The provider is also registered to provide personal care to people living in their own homes. This was not being provided at the time of this inspection and was therefore not assessed or reported on.

This unannounced inspection took place on 15 September 2016.

At the last comprehensive inspection on 3 September 2015 a breach of three legal requirements were found and the service was rated as requires improvement. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements.

During this inspection we found that the provider had followed their plan which they had told us would be completed by 30 November 2015 to show how the legal requirements were to be met.

There was a registered manager in post at the time of 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.

Risk assessments did not provide detailed information for staff about how to manage risks to people. This meant that people could receive care that was not safe.

The Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was acting in accordance with the requirements of the MCA including the DoLS. The provider was able to demonstrate how they supported people to make decisions about their care. Where people were unable to do so, there were records showing that decisions were being taken in their best interests. DoLS applications had been submitted to the appropriate authority. This meant that people did not have restrictions placed on them without the correct procedures being followed.

People were provided with a varied choice of meals. When necessary, people were given any extra help and support to eat. This ensured people had sufficient to eat and drink to keep them healthy.

Staff had received training, which was regularly updated in order to enable them to provide care in a way which ensured people's individual and changing needs were met. Peoples health needs were supported as they had access to a range of visiting health and social care professionals. Clear arrangements were also in place for ordering, storing, administering and disposing of people’s medicines.

The provider had a recruitment process in place and staff were only employed after all essential safety checks had been satisfactorily completed.

Staff treated people with dignity and respect. Mixed views were received about the number of people on duty in the home. At the time of our inspection sufficient staff were on duty to meet people’s needs.

A range of audit and quality assurance procedures were in place. However, these were not always as effective as they should have been.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:-

Is the service caring?

Our observations showed us that people living in the home were treated with respect at all times. Staff knew the routines that people had chosen and this was confirmed when we spoke with people living in the home. One person told us, 'Staff are very good here I would not want to leave.'

During our inspection we observed positive and meaningful interactions between staff and people living in the home in the form of laughter and relaxed conversation.

Is the service responsive?

We saw that people's individual social and physical needs were being met. People were encouraged to decide what they wanted to do each day and this was recorded on their cre plan. We saw that staff allowed time for the individual to fully understand their choices and the options offered to them. This showed us that staff supported the dignity of people and did not rush anyone into a quick decision.

Is the service safe?

Records we looked at showed us that risk assessments were completed for any activities inside and outside of the home. All assessments included an evaluation for the level of risk that was presented plus any actions to be taken to reduce or eliminate such risks. Lawful requirements under the Mental Capacity Act 2005 were recognised and staff expressed a thorough knowledge of matters relating to the Deprivation of Liberty Safeguards (DoLs).

Is the service effective?

When we spoke with people living in the home they told us that staff knew how they had chosen to be supported. One person told us, 'Staff know what I need and always know what I like.' We saw that people were relaxed and confident when discussing matters with staff. One person told us that, 'Staff are nice and I can always talk to them about any worries if I feel like it.'

Is the service well led?

Staff explained that they undertook regular training and we saw a list of dates when training was due to be updated. This showed that people were supported by staff members who knew how to provide any support in a safe and appropriate way. We saw that quality assurance systems were in place and the provider completed a monthly audit covering all areas of the home. This audit included observations of how the service and records could be improved.

An annual survey had been carried out, although the results had not been analysed or reported on. Policies and procedures had been reviewed and updated, although these were not all adequately detailed to provide guidance on how actions should be achieved.

There had been improvements to other areas of concern at the home; recruitment checks had been completed for one new staff member, care records were in the process of being updated and those we examined were detailed. Monitoring and guidance in relation to infection prevention and control had been updated.

Although the service continued to be non-compliant with this outcome, we recognise that improvement had been made and have therefore extended the timeframe for compliance given in our previous enforcement action.

People did not always receive the care and support they required to improve their health and well-being. Assessments were completed, although these did not identify actions that were required to reduce risks. Care records were not written in enough detail to provide clear guidance to staff members. We also found that evaluations of care plans did not identify where there had been issues. People told us that there was nothing for them to do and they had no stimulation at the home.

Appropriate actions had not been taken to make sure that people were safe from infection or to resolve infection prevention and control issues when they were identified.

Recruitment checks were not carried out or obtained prior to new staff members starting work with the service.

Staff rotas and training information showed there were not enough staff members and that training had not been kept up to date. People who used the service said there were not always enough staff available to meet their needs.

Systems were not in place to regularly check and monitor the way the service was run.

People told us they felt well cared for by staff members and that they received the care and treatment they expected. However, we found evidence during our inspection that people's care and treatment was not always planned and delivered in a way to ensure people's safety and welfare.

During our inspection we observed that people were cared for in a clean and hygienic environment. However, we found that people were at risk of infection because there was inappropriate infection control guidance available to staff.

We examined staff employment records which demonstrated to us that appropriate checks were not undertaken before staff began work.

We examined documentation which demonstrated to us that the provider regularly assessed and monitored the quality of service that people receive and acted on suggestions made.