Archived: Doddington Lodge

At this inspection, we found the registered provider was in breach of seven of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 that we identified during the last inspection. These shortfalls in the service are described throughout all sections of this report.

Doddington Lodge provides accommodation and personal care for up to 41 people, some of whom are living with dementia. At the time of our inspection, there were 30 people living at the home.

There was not 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 and associated regulations about how the service is run.

People were exposed to harm, both in terms of their physical environment as well as the care they received. Action had not been taken to address areas that required it which placed people at risk of injury and harm. A fire escape route identified as being obstructed did not get cleared at the time it was identified. People remained without hot water for over two months with no clear plan in place to remedy the situation.

People's risk assessments were not followed, which resulted in unsafe care and treatment. People's skin health was compromised due to guidance not being followed. The provider had not taken action where risks had been identified by staff and brought to their attention.

People’s nutritional dietary needs were not always identified or followed and people were not provided with the support they needed to eat and drink enough. People were at risk of malnutrition and of dehydration with people’s needs and abilities not routinely reviewed.

Complaints were not always appropriately responded to and lessons were not learnt

People were not always treated with dignity and respect. Care did not always centre on people as individuals. People’s care reviews were not completed and people’s preferences were not known by staff.

People were unable to enjoy their individual hobbies and interests. Staff were not always available to support people with the things they enjoyed doing. Professional and medical guidance was not followed, which meant people's health needs were not always met.

There was no effective governance and oversight of the service. The provider and the manager did not have understanding of where they were failing to meet people’s needs. The provider had not identified the concerns we highlighted during the course of our inspection.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We undertook this focussed inspection to check that they had followed their plan and to confirm whether they had improved how the service was managed.

This inspection took place on 5 July 2017 and was unannounced.

Doddington Lodge provides accommodation and personal care for up to 41 people, some of whom are living with dementia.

There was not a registered manager in post. There had been a temporary manager in post since June 2016. 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 and associated regulations about how the service is run.

The manager had already applied to CQC to become a registered manager. They had a clear view and understanding of the home and people and staff felt assured that the manager would make a good registered manager.

There were effective systems in place relating to the governance and management of the home.

Where risks to people had been identified, appropriate action had been taken. Improvement in the service had been maintained and the provider and manager shared a clear view to drive further improvements in the home .

Quality assurance systems were in place. The provider and manager maintained a clear overview of the home.

We undertook this comprehensive inspection to check that they had followed their plan and to confirm whether they now met legal requirements.

This inspection took place on 23 November 2016 and was unannounced.

Doddington Lodge provides accommodation and personal care for up to 41 people, some of whom are living with dementia. At the time of our inspection there were 24 people living at the home. Doddington Lodge had two separate living areas. The ‘A side’ for people living with dementia and the B side for people who have complex health needs.

There was not a registered manager in post. There had been a temporary manager in post since June 2016. 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 and associated regulations about how the service is run.

At this inspection we found the registered provider was no longer in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 that we identified during the last inspection. These were in relation to person centred care, safe care and support, governance of the service, nutrition, staffing and for failing to display their rating.

There was effective leadership in the service but these are interim arrangements and until a registered manager is in post we could not be assured that the pace of improvement would be sustained.

Quality assurance systems were in place. There was a clear drive to improve the care and support for the people that lived there.

People were kept safe from harm. There were enough staff on duty to keep people safe and respond to people’s health needs at the times when they needed support.

People were treated with dignity and respect.

People received the appropriate support to maintain healthy nutrition and ensure people’s specific dietary needs were catered for.

People were supported to access health and social care services to maintain and promote their health and well-being when needed.

Staff did not start working with people until checks had been made to make sure they were suitable to support and care for the people living in the home.

People received their medicines safely. Medicines were ordered, stored administered and disposed of safely.

People were given support to make choices and decisions about their care and support. Where people could not make specific decisions themselves these were made in their best interests by people who knew them well.

We undertook this comprehensive inspection to check that they had followed their plan and to confirm whether they now met legal requirements.

This inspection took place on 30 March 2016 and was unannounced.

Doddington Lodge provides accommodation and personal care for up to 41 people, some of whom are living with dementia. At the time of our inspection there were 34 people living at the home. Doddington Lodge had two separate living areas. The A side for people living with dementia and the B side for people who have complex health needs.

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 and associated regulations about how the service is run.

At this inspection we found the registered provider was still in breach of three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 that we identified during the last inspection. These were Regulation 9 in relation to person centred care, Regulation 12 in relation to safe care and support and Regulation 17 in relation to the governance of the service. They were no longer in breach of Regulation 11 as they had improved how they worked to the principles of the Mental Capacity Act (2005). We found other breaches of regulations. These were, Regulation 14 in relation to nutrition, Regulation 18 in relation to staffing and Regulation 20A for failing to display their rating. These shortfalls in the service are described throughout all sections of this report.

There was no effective leadership in the service. Quality assurance systems in place had not identified the concerns that we identified during the inspection. There were no clear actions planned or taken to improve the care and treatment that people received. We had concerns in relation to how the service was managed.

People were not always kept safe from harm. There were not enough staff on duty to keep people safe or to respond to people’s health needs at the times when they needed support.

People were not always treated with dignity and respect.

People did not receive the appropriate support to maintain healthy nutrition and people’s specific dietary needs were not always catered for.

People were not always supported to access health and social care services to maintain and promote their health and well-being when needed.

The provider had not clearly displayed their quality rating. Information supplied by the provider to the public did not reflect the last CQC inspection rating. This is a requirement to ensure that the provider is transparent about the quality of the service they provide.

Staff did not start working with people until checks had been made to make sure they were suitable to support and care for the people living in the home.

People did receive their medicines safely. Medicines were ordered, stored administered and disposed of safely.

People were given support to make choices and decisions about their care and support. Where people could not make specific decisions themselves these were made in their best interests by people who knew them well.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review; if we have not taken immediate action to propose to cancel the provider’s registration of the service, it 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.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service.

This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

This is a summary of what we found '

Is the service caring?

We observed the care and support given to people at Doddington Lodge. We observed that staff encouraged people to be independent when eating meals and allowed them to eat at their own pace.

We saw staff were caring and patient when supporting people. Staff respected people and treated them with dignity.

People we spoke with told us, 'They help me do what I can. They are very respectful'.

One member of staff told us, 'I imagine the person I am caring for is my own mum or dad'.

Is the service responsive?

People's needs had been assessed but the information available to staff was not always up to date.

The provider worked with other healthcare professionals to ensure people's health needs were looked after.

The provider employed an activities co-ordinator who provided a range of activities such as bingo, quiz's and skittles. They met with people weekly to support them to choose which activities they would like for the week.

Is the service safe?

People were cared for in an environment which was clean and hygienic. Equipment was mostly well maintained. When we spoke with the registered manager about concerns we had about a piece of equipment this was addressed during our visit. Protective equipment such as gloves and aprons were readily available to staff along with hand washing facilities.

Is the service effective?

It was clear from our observations that staff understood people's needs at Doddington Lodge. People were supported in a way which promoted their independence.

Staff responded to people quickly when they needed assistance as there were sufficient staff on duty.

Is the service well led?

Quality assurance systems at Doddington Lodge were mostly informal and not always recorded. The provider had sought people's views on the service but this wasn't shared with people, their families or staff. The registered manager had informal discussions to gain feedback from people and staff and this was confirmed when we spoke with them. Staff told us they found management approachable and they listened to their concerns.

People said they felt safe living at the home. One person commented, "The staff treat me well and are very caring. I can see the doctor when I need to and they all keep an eye on my health".

Staff told us they had attended a range of training courses to equip them with the knowledge and skills to effectively carry out their duties.

There was evidence that residents' views and the opinion of their relatives were being sought and listened to. The majority of people told us they were asked on a daily basis if they were OK and could attend formal meetings if they wished. The provider conducted surveys to gain people's views about their care and how the service was run.

The provider monitored the service with systems in place to enable them to identify problems swiftly and act upon them to keep people safe. The management arrangements in place were effective which meant that the service was well led.

We viewed records that showed people had been involved in and consulted about their care and support. People received a care needs assessment prior to being admitted to the home. We saw that staff supported people sensitively and politely. We spoke to people who said staff promoted their privacy and dignity whilst delivering their care.

One person said, 'I feel safe in the home and staff listen to any concerns I might have. I would not hesitate to make a complaint if I had one'. Staff spoke of their awareness of how to keep people safe from harm.

People told us that the staff asked them if they were alright and if they were happy with everything. They said that they were able to express their wishes and share their views about how they were feeling. People said if they had any concerns or worries they would speak with a member of staff or the manager.