Archived: Parsonage Lodge EMI

Parsonage Lodge EMI provides care for up to 14 people who need support with their personal care. The service provides support for older people and people living with dementia. The service is a large, converted property. Accommodation is arranged over three floors. The service has single and double bedrooms. A passenger lift and stair lift are available to assist people to get to the upper floors. There is an enclosed garden to the rear of the property. At the time of our inspection there were 11 people living at the service.

A registered manager was working at the service at the time of the inspection; they are also one of the registered providers. 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. The registered manager had delegated some responsibilities for the management of people’s care to a manager.

At our two previous inspections we found that the provider was in breach of a number of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and breaches of the Care Quality Commission (Registration) Regulations 2009. At this inspection we found that the provider had not taken sufficient action to improve the quality of the service and breaches of Regulations continued.

The registered manager was not leading the staff team or managing the service on a day to day basis. They did not have the required level of oversight. The poor performance of staff went unchecked and people were not treated with the dignity and respect they deserved.

Staff did not understand the needs of people who were living with dementia and there was a risk that some people were the subject of abuse at times. People were not treated equally; staff listened to what some people had to say but ignored others. For example, people who asked for food or drinks were often told to “Wait your turn” or were told the drink was being made when it was not.

Staff knew the possible signs of abuse; but had not recognised that the way they spoke to some people was potentially abusive. Staff did not speak to people with respect and told people in loud abrupt tones to, “Stop shouting”, “Be patient” and when one person asked for a cup of tea, they were told, “Not you, you’ve just had one”. Staff leaned over people sitting in armchairs, rather than being at the same level when they spoke to them. We observed that one member of staff wagged a finger in a person’s face as they spoke with them. The person shrank back from the staff member.

People were not treated with compassion and kindness at all times and their dignity was not respected. Staff working at the service had not taken time to build relationships with people and did not know them well. Communication between staff and people was not consistently good. People were not offered choices in ways that they understood and staff did not take time to present options to people in ways that would not confuse them.

Staff recruitment systems were in place. Sufficient checks had not been completed to make sure that staff did not pose a risk to people using the service and to check they had suitable skills, knowledge and experience. Disclosure and Barring Service (DBS) criminal records checks were not in place for new staff. New staff had completed an induction. However, the registered manager was not following current good practice and staff had not started to work towards a Care Certificate.

Staff had completed some training since our last inspection but checks had not been completed to make sure that they used their new skills and knowledge to provide safe and consistent care and support. Training in dignity and respect and safeguarding people had not taken place. An analysis of staff training needs had been completed. Further training and competency assessment were required to make sure that staff had all the skills and knowledge they needed to provide good quality care and meet people’s individual needs.

Emergency plans were in place but staff had not been trained to use equipment provided to evacuate people safely from the building.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and manager were unclear about their responsibilities under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Following our last inspection the registered manager had assessed people’s risk of being deprived of their liberty and made applications to Supervisory bodies to lawfully deprive everyone living at the service of their liberty, including those they had not assessed as being at risk. Conditions placed on people’s DoLS authorisations were not used to plan their care. Processes were not in operation to assess people’s capacity and make decisions in their best interests.

People’s needs had been assessed. Reviews of care plans had been completed, however changes in people’s needs had not always been identified and the care they received had not been planned to make sure it met their needs. People and their relatives had not been asked about their preferences of care and people did not always receive their care in the way they preferred.

Some people needed to use special cushions or mattresses to reduce the risk of them developing pressure ulcers. Staff had not taken action to make sure that these were used safely when alarm lights came on. Mattresses were not always set at the correct pressure to provide people with the right support and maximum benefit. People were not supported to go to the toilet or to change their continence products regularly. Advice from community nurses was not being followed and this put people’s skin at risk of damage.

Detailed guidance was not provided to staff about how to move and transfer people safely and the guidance that was in place was not changed when people’s needs changed. One person was moved in a wheelchair without the footplates being used properly which put them at risk.

Medicines management processes were in place. There was a risk that people did not always receive the medicines they needed when they needed them to keep them safe and well. Some people were prescribed medicines when they needed them such as pain relief. Guidance was not in place for staff to make sure that they knew when to offer these medicines to people. The application of prescribed creams was not recorded and guidance had not been given to staff about how, when and where to apply the creams to make sure they were used to best effect.

Changes in people’s health had been identified. Food was not prepared to meet some people’s specialist dietary needs, including diabetics and people who were at risk of losing weight and people who were at risk of becoming unwell. Choices of food were limited and the second option was often the same choice, an omelette.

The activities on offer to people were very limited and we observed people sitting doing not very much and without any interaction from staff on a number of occasions.

The provider had a complaints policy in place; they told us they had not received any complaints since our last inspection.

Regular checks on the quality of the service provided had been completed, however the registered manager was not aware of the shortfalls in the quality of the service that were found at the inspection. Information from people about their experiences of the care had been obtained but the registered manager had not reviewed these to see if any action was required.

Records were kept about the care people received and about the day to day running of the service. These were not always accurate.

The registered provider had not taken action to notify the Care Quality Commission of significant events that happened at the service, such as the outcomes of DoLS applications and when people had died.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures.

At this inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and breaches of the Care Quality Commission (Registration) Regulations 2009. CQC is now considering the appropriate regulatory response to resolve the problems we found.

We found the service was safe because people were protected against the risks associated with medicines. We found there were appropriate arrangements were in place for recording the administration of medicines.

People told us that the service responded to their health needs quickly and that staff talked to them regularly about their plan of care and any changes that may be needed. People spoken with and observations made, did not raise any concerns with regard to the quality of care received. All staff spoken with demonstrated an appropriate level of experience and knowledge that enabled them to support the people who lived at the service with their needs effectively.

We saw that the people who used the service were making choices about their lives and were part of the decision making process. People had their own individual routines which were respected.

During this inspection we undertook a tour of the building and reviewed the action plan sent to us by the provider. We noted the improvements made with regard to carpeting and internal decoration and found the service to now be compliant. No further action with regard to the outstanding compliance action is planned.

Systems for quality assessment and improvement were in place. Information about peoples' experiences had been asked for and gathered in such a way to allow for monitoring of risks and the quality of care delivery. Representatives and staff were asked for their views about their care and treatment and they were acted on.

At the time of inspection people were sitting in the lounge. Some people were having a drink and others were talking to staff. A relaxed atmosphere was noted. During the inspection we noted that people's needs were being met and that staff were treating people with dignity and respect. We spoke with two relatives during the time of our visit. They were happy and content with regard to the quality of care provided at the service.

Concerns were found with the support of healthcare and the quality of care planning to meet people's needs. We carried out a tour of the building and found a lack of general maintenance and repair and there was no planned programme of renewal. Not all records were detailed, person centred or gave guidance for staff to follow and deliver care which protected people from the risks.

We saw appropriate arrangements were in place for recording the administration of medicines. These records were clear and fully completed and documented that people had been given their prescribed medicines correctly.

We saw people were not receiving their medicines as prescribed and the record of controlled drugs administered was inaccurate.

People said that they were happy with the care and support they were receiving and that their needs were being met in all areas. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care. People told us that the service responded to their mental health needs quickly and that the manager talked to them regularly about their plan of care and any changes that may be needed.

The provider and staff were clear about what action would need to be taken if they witnessed abuse or if an alert was raised. Staff we spoke with demonstrated that they knew the process for reporting abuse from both inside and outside the service.

However people were not protected against the risks associated with medicines because the provider had not taken appropriate steps to manage medicines in accordance with guidance. They had not ensured all medicines were stored appropriately and errors were found within the controlled drugs book.