Archived: Groby Lodge

Some areas of the service were unclean and not well maintained. Flooring in people's ensuites bathrooms, communal toilets and the laundry had debris and was not in good condition. Wooden panelling in the kitchen and the banister for the main stair case was damaged exposing the wood. Some support equipment was rusty and damaged. Light switch cords were stained and did not have a protective cover on them to enable them to be cleaned effectively. This compromised infection control measures and the effectiveness of cleaning, which meant this could contribute to the spread of infection to people and staff.

Quality assurance audits undertaken by the provider, were not effective in identifying the shortfalls found during the inspection.

We found the following examples of good practice.

• Staff and people took part in a regular testing regime. This was to identify any person who may be positive to Covid-19 without symptoms. Where staff displayed symptoms or became unwell, the provider supported them to access Covid-19 testing.

• There were clear processes for essential visitors. There was an infection control station in the entrance of the service, which contained Personal Protective Equipment (PPE) and sanitising gel. On arrival to the service, visitors had their temperatures taken and a health declaration was completed.

• Communal area’s had been set up to promote social distancing between people who used the service.

• Staff wore Personal Protective Equipment (PPE) inline with national guidance.

• Where people had been admitted to the service, the national guidance relating to admission to care home had been followed. This included a period of isolation.

• People using the service were given information regarding the Covid-19 pandemic to support them to inform their choices around their care.

Further information is in the detailed findings below.

People’s experience of using this service: People felt safe living at Groby Lodge and their relatives were confident they were being looked after by enough appropriately skilled staff. People’s risks were identified and managed well by a proactive management team. People were supported to take their medicines regularly in a safe way. People were protected from the risk of infection by the procedures in place.

People were cared for by a kind, respectful and dedicated team. People felt comfortable and at ease with the friendly staff at the home. Staff took the time to really get to know people to be able to provide them with personalised care. People were involved in their care and were able to express their views, which were listened to and acted on. People were given choice and were empowered to be independent where possible. People’s dignity and privacy was of utmost importance to staff.

People’s needs were assessed prior to moving into the home, this included finding out their likes and dislikes. People were supported by staff who were inducted, trained and regularly supervised. People’s eating and drinking needs and preferences were catered for in a dignified and caring way. People were supported to access healthcare when they required it, staff were proactive in identifying any health concerns and addressing these promptly.

People were cared for by a kind, respectful and dedicated team. People felt comfortable and at ease with the friendly staff at the home. Staff took the time to get to know people and ensured they received personalised care. People were involved in their care and were able to express their views, which were listened to and acted on. People were given choice and were supported to be independent where possible. People’s dignity and privacy was of utmost importance to staff.

People were supported in an individualised way. People’s care plans were personalised and gave staff clear guidelines to make sure people received the care the way they wanted it. Staff took a genuine interest in people and got to know them and their families. People had no complaints or concerns but knew how to raise these if they did.

People felt the service was managed well and knew the whole team. People’s opinions were actively sought. The registered manager, management team and staff worked effectively together to ensure consistent high-quality service.

Rating at last inspection: Good - last report published 11 October 2016.

Why we inspected: This was a scheduled inspection.

Follow up: We will continue to review information we receive about the service until the next scheduled inspection. If we receive any information of concern, we may inspect sooner than scheduled.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Groby lodge is a residential home which provides care to older people including some people who are living with dementia. Groby lodge is registered to provide care for up to 12 people. At the time of our inspection there were 12 people living at the home, however one person was in hospital.

A registered manager was in post. The registered manager was also the provider, and they were supported by a care manager at the home. 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.

At the last two inspections of the service in October 2013 and June 2014 we asked the provider to take action. We asked the provider to make improvements in the storage of and administration of people’s medicines. We received an action plan from the provider which outlined the action they were going to take which advised us of their plan to be compliant by October 2014. We found that the provider had taken the appropriate action. Medicines were ordered and stored safely, and staff were trained to administer the medicines people required. There is still some action needed where PRN or as required medicines were not administered consistently. Staff sought medical advice and support from health care professionals.

At the last inspection of the service in June 2014 we asked the provider to take action. We asked the provider to make improvements and provide accessible personal evacuation plans. We received an action plan from the provider which outlined the action they were going to take which advised us of their plan to be compliant by October 2014. At this inspection we found that improvements had been made. We looked at the personal evacuation plans (PEEP’s) which were kept securely along with other documents and were placed near the fire board and main exit from the home. Copies of the PEEP’s were also kept in each person’s file and reviewed regularly.

At the last inspection of the service in June 2014 we asked the provider to take action. We asked the provider to make improvements to the audits, checks and governance in the home. We received an action plan from the provider which outlined the action they were going to take which advised us of their plan to be compliant by October 2014. At this inspection we found that improvements had been made. A series of checks had been introduced that were overseen by the care manager and then checked by the provider.

People felt staff were kind and caring, and their privacy and dignity was respected in the delivery of care and their choice of lifestyle. Relatives we spoke with were also complimentary about the staff and the care offered to their relatives. People were involved in the review of their care plan, and when appropriate were happy for their relatives to be involved. We observed staff offered people everyday choices and respected their decisions. People’s care and support needs had been assessed and people were involved in the development of their plan of care. Staff had access to people’s care plans and received regular updates about people’s care needs. Care plans included changes to peoples care and treatment, and people attended routine health checks.

People were provided with a choice of meals that met their dietary needs. The catering staff were provided with up to date information about people’s dietary needs, and sought people’s opinions to meet their individual meal choices. There were sufficient person centred activities provided on a regular basis. Staff had a good understanding of people’s care needs, and people were able to maintain contact with family and friends as visitors were welcome without undue restrictions.

Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the home. They received induction and on-going training for their specific job role, and were able to explain how they kept people safe from abuse. Staff were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse.

There were sufficient staff available to meet people’s personal care needs most of the time and we saw staff worked in a co-ordinated manner.

Staff told us they had access to information about people’s care and support needs and what was important to people. Staff knew they could make comments or raise concerns with the management team about the way the service was run and knew these would be acted on.

The provider had a clear management structure within the home, which meant that the staff were aware who to contact out of hours. The provider undertook quality monitoring in the home supported by the care manager and their deputy. The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service, their relatives and health and social care professionals. We received positive feedback from a visiting professional and the contracting staff from the local authority with regard to the care and service offered to people. Staff were aware of the reporting procedure for faults and repairs and had access to the maintenance to manage any emergency repairs.

When we spoke with a relative they said, 'When we walked in here the atmosphere was great, bright and open. X [name of person] has a lovely view from the window in her bedroom.' They went on to say, 'The change is amazing, she's brighter and more alert. [Person using the service named] seems to be better on her legs as she's walking more here.' And added, 'The staff are great, it's certainly dispelled my fears of being cared for.'

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and in how to submit an application.

Care plans reflected people's needs and staff understood how to support people individual needs in line with their care plans. Care plans were written in an individual way ensuring people received personalised care from staff. There were arrangements in place to deal with foreseeable emergencies such as individual evacuation plans in case of a serious event such as a fire.

Equipment in the home was well maintained and serviced regularly. We found medicines were signed for and distributed to people safely. However, we found the appropriate arrangements were not always in place around the recording, storing and management of medicines.

Is the service effective?

We noted that the toilet bowls in both the ground floor toilets were not adequately fixed to the floor, which could pose a risk to people. We also saw some of the tiled floor was missing below the rim of the toilet bowls. That meant that cleaning could not be done effectively and the area properly disinfected. Both these items were attended to by the staff whilst we were at the home. People's health and care needs were assessed, and they and their representatives were involved in the agreement of their plans of care. We saw that people were treated with respect and dignity by staff.

Is the service caring?

The service worked well with other agencies and services to make sure people received care appropriate to their needs. We saw where people were supported by visiting doctors, specialists and district nurses on a regular basis. One relative told us, 'The staff are great, it's certainly dispelled my fears of being cared for.'

Is the service responsive?

We found that the periodic monitoring completed by staff was inadequate and required to be re-evaluated. This failed to identify issues on both the fire and evacuation and medication systems.

Is the service well-led?

Quality assurance systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. People using the service and their relatives, were invited to complete an annual satisfaction survey. Where shortfalls or concerns were raised these were recognised and a plan put in place for them to be addressed.

We found that people were able to make informed decisions about their care and support. One person told us 'it's alright here. I am always respected and the staff always knock on my bedroom door before coming in.' One relative told us their family member 'always looks well cared for. We are very satisfied with the care and support here.'

We found people experienced care and support that met their needs and protected their rights. Care and support was delivered in a way that met people's needs and ensured their safety and welfare.

We found that the provider did not have appropriate arrangements in place to manage medicines which meant that people may not be protected against the risks associated with medicines. People's medication was not always stored safely and securely. Controlled drugs were not stored appropriately and the number of controlled drugs recorded did not match the number stored.

We found staff were supported in their work and were confident that they were able to provide the care required.

People were not always protected from the risks of unsafe or inappropriate care and treatment because appropriate information relating to people's risks was not always being completed in a reliable way. We found the provider had systems in place relating to record keeping.

We found staff recruitment records had been updated to include confirmation of people's identity which included a photograph.