Eighton Lodge Residential Care Home

Eighton Lodge is a residential care home providing personal care to up to 47 people. The service provides support to people aged 65 and over, some of whom are living with a dementia. At the time of our inspection there were 43 people using the service.

People’s experience of using this service and what we found

People’s medicines were not managed safely. Records did not provide assurances that people were getting their medicines as prescribed or when required. The manager had not completed the medicine audits for a month and issues with medicine records had not been identified during this time. Incidents relating to medicines management had not always been recorded correctly or investigated.

Quality and assurance records in place were not fully completed or were ineffective. We found that from May 2022 onwards there was no effective oversight by the manager. We made a recommendation at our last inspection that records relating to the administration of people’s creams and patches should be accurate and complete. At this inspection we found that the provider had not made improvements to record keeping.

People’s care records showed that staff had completed detailed assessments of people’s needs but care plans created from these did not include of all the information required for staff to effectively support them. We were assured that staff were meeting people’s needs and care records required reviewing to include all of the support staff provided.

Staff were not always following best practice guidance relating to infection prevention and control. People’s personal care items were accessible, for example creams, shower gels and items used for bathing were left in corridors and bathrooms.

We have made a recommendation relating to best practice guidance for infection prevention and control .

Staff followed government guidance relating to COVID-19, wore appropriate PPE and ensured all professional visitors provided a negative lateral flow test before entering the home.

People and their relatives were complementary about the support provided by staff. Relatives told us that staff had supported people throughout the pandemic and kept them safe. During the inspection we observed many positive interactions between staff and people.

Care plans did not always contain all of the information required to meet people’s needs. Staff told us what support people required and acknowledged that this information was missing from some care records. People and relatives were involved in their care planning and staff knew people’s preferences and choices for their care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff had received on-going training from the provider and had regular supervision sessions. There were enough staff on duty to meet people’s needs and staffing levels were reviewed at regular intervals. Permanent staff were recruited safely but we found records did not show if agency staff had received the provider’s full induction.

People were complementary about the food provided and staff supported some people to maintain a balanced diet. Staff worked in partnership with other healthcare professionals to meet people’s needs a timely way.

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

Rating at last inspection and update

The last rating for this service was good (published 02 March 2022). At our last inspection we recommended that the provider ensured that accurate and complete records were kept regarding medicines administered in the form of a patch or cream. At this inspection we found that the provider had not acted on this recommendation and records continued to not be accurate or fully completed.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We received concerns in relation to medicines management and person-centred care. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. Following the inspection the provider has taken action to address the issues identified and is working in partnership with the CQC, North East and North Cumbria Integrated Care Board (ICB) and the Local Authority.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Eighton Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management, the quality and assurance systems in place and record keeping at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Eighton Lodge is a residential care home providing personal care to people aged 65 and over, including those living with dementia. At the time of our inspection 42 people were being supported. The service can support up to 47 people.

People’s experience of using this service and what we found

People living at the home told us they were happy with the care and support they received. The home had a welcoming and warm atmosphere and people were treated in a respectful and compassionate way. We saw positive interactions between staff and the people who lived there.

We have made a recommendation about recording the administration of prescribed patches and creams.

Staff understood how to protect people from abuse and recruitment processes ensured new staff were suitable to work with vulnerable people. Systems were in place to help identify risks to people and ensure that such risks were managed and mitigated effectively.

There were enough staff to meet people's care and support needs. Staff had completed training and had their competency checked to enable them to perform their role.

Infection control was managed effectively. Staff wore appropriate PPE and the home was clean and well maintained. Visiting was facilitated in a safe way in line with current guidance to ensure people's well-being was promoted by maintaining relationships that were important to them.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Since the last inspection, a new manager had been appointed to the home. People, their relatives and staff spoke positively about the manager.

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

Rating at last inspection

The last rating for this service was good (published 24 April 2018).

Why we inspected

We undertook this inspection as part of a random selection of services rated good and outstanding.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The inspection took place on 21 November 2017 and was unannounced. This meant staff did not know we were visiting.

We last inspected Eighton Lodge on 10 and 11 October 2016 and rated the service as Requires Improvement. At this inspection we found the service had improved to Good.

The service had a registered manager who was on duty during the course of our visit. 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 our last inspection we found breaches of regulations in relation to building work hazards and risks in relation to cleaning products being securely stored. The provider sent us an action plan telling us when and how these issues had been addressed. We saw these requirements had now been met.

Staff and the management team understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding adults. People and relatives we spoke with told us they felt safe at the home.

Where potential risks had been identified an assessment had been completed to keep people as safe as possible. Health and safety checks were completed and procedures were in place to deal with emergency situations.

The home was clean, and we saw staff followed good practice in relation to wearing personal protective equipment when providing people with care and support. The environment had been extensively refurbished since our last visit and people told us they liked the décor.

Medicines were managed safely. We saw medicines being administered to people in a safe and caring way. People confirmed they received their medicines at the correct time and they were always made available to them. We saw nursing staff working with community professionals to ensure end of life anticipatory medicines were available to people when needed.

We found there were sufficient care staff deployed to provide people’s care in a timely manner. We saw that recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people.

The registered manager shared learning from feedback and safeguarding events with the staff team through recorded meetings. From previous inspection visits by CQC and the local authority in 2016, the registered manager showed us their completed action plan and a recent local authority inspection visit in 2017 had given positive feedback. This showed the service had addressed areas for improvement.

Staff received the support and training they required. Records confirmed training, supervisions and appraisals were up to date. Staff told us they were supported by the home’s management, especially the team leaders.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People gave positive feedback about the meals they were served at the home. They received the support they needed with eating and drinking by the staff team and we observed people being given choices, using small plates with the meal choices on instead of just a written menu.

We saw people’s healthcare needs were well monitored and records in relation to the monitoring of people’s health, nutrition and pressure care were recorded. The service had engaged well with a pilot scheme run by the local dietetics service to improve people's nutritional health.

People were supported by care staff who were aware of how to protect their privacy and dignity and show them respect at all times.

People’s needs were assessed before they came to live at the service and then personalised care plans were developed and regularly reviewed, to support staff in caring for people the way they preferred.

The service provided a range of activities and support for people to access the community. Despite the lack of activity staff due to sickness, the care staff team had taken on this role with enthusiasm.

The provider had an effective complaints procedure in place and people who used the service, and family members, were aware of how to make a complaint. Feedback systems were in place to obtain people’s views about the quality of the service.

There was a robust system of checks and audits in place that the management team used to check the quality and safety of the home, as well as to drive improvement in areas such as dementia care with better signage recently ordered for the service.

The service had good links with the local community and local organisations and supported services such as Age UK to use its facilities. The service had also worked closely with the local hospice to volunteer and support fundraising events.

Eighton Lodge Residential Care Home provides personal care and accommodation for up to 47 older people, including people with dementia-related conditions. At the time of our inspection there were 34 people living at the home.

The service had a registered manager. 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 there were hazards resulting from work being carried out in the building which compromised people’s safety. These hazards had not been recognised and no efforts were made to control the risks until we brought them to the attention of the management. We highlighted further potential risks including a lack of diligence in making sure domestic equipment, and in one instance a cleaning chemical, were safely stored to prevent the likelihood of harm occurring.

There were established processes for protecting people from abuse and responding to any safeguarding concerns. Risks to people’s welfare had been assessed and measures were in place to safely provide individual care and support.

Any new staff were properly checked and vetted before they started working at the home. Sufficient staff were employed to ensure people were provided with consistent care and staffing levels were kept under review. Training provision had been improved to equip staff with the necessary skills to care for people effectively. Regular supervision and annual appraisals were carried out to assess performance and support staff in their personal development.

People were supported to access healthcare services to maintain their health and well-being. A varied diet was offered to aid good nutrition and when necessary, dietetic advice was obtained. People told us they enjoyed the food. We have made a recommendation about the way staff are deployed at mealtimes to make sure people are properly supervised.

People’s rights under mental capacity law were protected and formal processes were undertaken when people were unable to make important decisions about their care. People and their representatives were consulted about care and treatment and advocacy services could be arranged if needed.

Staff sought permission before providing support and encouraged people to make choices in their daily living. They were caring in their approach and respected people’s privacy and dignity. People and their relatives spoke highly of the care provided. There was a clear complaints procedure in place if anyone was unhappy with the service they received.

Care was appropriately planned, tailored to people’s individual needs and preferences, and adapted in response to any changes. People were offered a good range of social activities, entertainment and opportunities to out into the local and wider community.

The service had a registered manager who was supported in their role and provided leadership to the staff. Methods of seeking feedback about the service were being improved upon. Systems for monitoring standards in the home had not identified the shortfalls we found during the inspection. The quality and safety of the service needed to be kept under closer scrutiny.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to the safety and governance of the service. You can see what action we told the provider to take at the back of the full version of this report.

People had their needs assessed and this information was used to develop personalised care plans. Family members gave very positive feedback about both their relative's care and the care staff. One family member commented, "Staff look competent and know what they are doing."

We found the provider had systems in place to ensure people received the medication they needed. Medication was administered by senior staff who had completed relevant training.

The provider had effective recruitment and selection procedures in place. Relatives and carers told us they were happy with the care that staff provided. One relative commented, 'Staff are excellent, we have no concerns with the staff.'

People and their relatives knew how to complain and were happy with the care they received. One family member commented, 'Excellent care, it's like a five star hotel, no faults at all.' Relatives told us they knew how to complain and would have no problem complaining if they needed to.

We found some care records including care plans were incomplete and inaccurate and had not been updated in a timely manner.

They said that the care workers were 'all very pleasant' and they were 'on very good terms'.

We were told that the food within the home was 'very good' and that they 'enjoyed the atmosphere throughout'.

People who used the service said they 'definitely feel safe' and that they 'knew who to complain to, if there was anything'.

People spoken to had access to their care plan and we were told that any changes in their care had been discussed with them.

We also spoke to relatives of people who used the service and they told us that the environment was 'OK and very clean', there are 'things going on, such as trips out', the 'staff treat residents well', and there is 'no problem in raising issues'.