Suffolk Lodge

Suffolk Lodge is a care home without nursing that provides a service to up to 40 older people living with dementia and/or a physical disability. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home is split into 5 smaller units of seven to eight bedrooms. There are three units on the ground floor and two on the first floor. One of the two first floor units was closed with all people living in the other four units. At the time of our inspection there were 29 people living at the service.

There was a registered manager as required. A registered manager is a person who has registered with the CQC 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 and deputy manager were present and assisted us on both days of this inspection.

We last inspected the service on 22 and 23 August 2017. At that inspection we found the service required improvement. This was because improvements were needed to the safety of the premises, the safe storage of medicines and to ensure the premises were more suited to those living with dementia. We also found the provider had not established an effective system to enable them to ensure compliance with the fundamental standards. Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions of safe, effective and well-led to at least good. At this inspection we found the provider and registered manager had done all they said they would do and had improved the service to an overall rating of good, with a rating of good in all key questions.

Extensive work had been done on the safety of the building to ensure the premises were safe. Medicine storage had been addressed to ensure medicines were stored at safe temperatures. Work had been completed in response to health and safety inspection concerns, recommendations from a legionella risk assessment and work required following an inspection by the local Fire and Rescue Service.

The registered manager and the entire staff team had been involved in carrying out an audit of the premises to see where changes could be made to improve the 'dementia friendliness' of the premises and enhance the lives of the people living at Suffolk Lodge. The findings from the audit had been implemented, resulting in an environment that enhanced people's wellbeing and aided their independence. The provider had introduced a system that was successful in enabling them to monitor and ensure the service was compliant with the fundamental standards.

People felt safe living at the service and were protected from risks relating to their care and welfare. Staff knew how to recognise the signs of abuse and were aware of actions to take if they felt people were at risk.

People were protected by the provider's recruitment processes. Safe recruitment practices were followed before new staff were employed to work with people. Required checks were made to ensure staff were of good character and suitable for their role.

People received care and support from staff who knew them well. Staff training was up to date and staff felt they received the training they needed to carry out their work safely and effectively. People received support that was individualised to their personal preferences and needs. Their needs were monitored and care plans were reviewed monthly or as changes occurred.

People received effective health care and support. Medicines were stored and handled correctly and safely. 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.

Meals were nutritious and varied. People told us they enjoyed the meals at the service and confirmed they were given choices.

People were treated with care and kindness. People's wellbeing was protected and all interactions observed between staff and people living at the service were respectful and friendly. People confirmed staff respected their privacy and dignity.

People and relatives were aware of how to make a complaint. They told us they could approach management and staff with any concerns and felt they would listen and take action. They benefitted from living at a service that had an open and friendly culture and from a staff team that were happy in their work.

People living at the service and their relatives felt there was a good atmosphere and thought the service was managed well. Staff also felt the service was well-managed. They told us the management were open with them and communicated what was happening at the service and with the people living there.

Suffolk Lodge is a care home without nursing that provides a service to up to 40 older people living with dementia. The home is split into 5 smaller units of seven to eight bedrooms. There are three units on the ground floor and two on the first floor. At the time of our inspection there were 19 people living at the service. One of the two first floor units was closed with all people living in the other four units.

Suffolk Lodge is required to have a registered manager. The registered manager for the service left in October 2016. In January 2017 a new manager was employed who has applied to be registered with the Care Quality Commission (CQC). Her CQC application is currently being processed. A registered manager is a person who has registered with the CQC 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 new manager was present and assisted us during this inspection.

We found people were not always protected from environmental risks to their safety. Premises risk assessments and health and safety audits were carried out but issues identified were not always dealt with promptly and other risks were not identified by the systems in place. While some actions had been taken to make the environment 'dementia friendly', overall the measures taken did not help people to compensate for sensory loss and cognitive impairment and did not contribute to supporting their independence. We have recommended that the provider explores best practice guidelines on the use of name badges for staff working with people living with dementia.

The service was mostly managed well but there was no effective system for the provider to ensure the service was fully compliant with the fundamental standards (Regulations 8 to 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014). This was especially apparent in relation to concerns or issues regarding the premises.

Medicines were mostly stored and handled correctly and safely. Action needed to be taken to ensure safe medicine storage in heatwave conditions.

Relatives felt people living at the service were protected from abuse. Staff knew how to recognise the signs of abuse and were aware of actions to take if they felt people were at risk.

People received care and support from staff who knew them well. Their diversity needs were identified and incorporated into their care plans. People's right to confidentiality was protected and they received support that was individualised to their personal preferences and needs. Their needs were monitored and care plans were reviewed regularly or as changes occurred.

People's rights to make their own decisions, where possible, were protected and staff were aware of their responsibilities to ensure those rights were promoted. 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 received effective health care and support. They saw their GP and other health professionals when needed. Meals were nutritious and varied. We saw people were enjoying their meals on both days of the inspection and saw they were given choices.

People were treated with care and kindness. All interactions observed between staff and people living at the service were respectful and friendly. People confirmed staff respected their privacy and dignity and always asked their consent before providing care.

Relatives were aware of how to make a complaint and told us they would speak to the manager or one of the staff. They told us they could approach management and staff with any concerns and felt they would listen and take action.

People benefitted from living at a service that had an open and friendly culture and from a staff team that were happy in their work. Staff told us the management were open with them and communicated what was happening at the service and with the people living there.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured that the premises were safe to use for their intended purpose and the premises were not always used in a safe way. The premises and environment were not suitable for the purpose of meeting the needs of people with dementia. The registered person had not established an effective system to enable them to ensure compliance with the fundamental standards. You can see what action we have asked the provider to take in the full version of this report.

We carried out this focused inspection to check the service had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those areas where the provider had not met the relevant legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Suffolk Lodge on our website at www.cqc.org.uk.

Suffolk Lodge is a care home without nursing that provides a service to up to 40 older people, some of whom may be living with dementia. The home is divided into five smaller units, each accommodating seven or eight people.

The service had a registered manager who had been registered since 19 May 2015. 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 provider had addressed the concerns identified at the last inspection. Effective systems had been put in place to ensure all staff received appropriate training and updates in line with the provider's policy and the fundamental standards.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' 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 staff were caring, skilled and patient when supporting people. One person said 'I have no complaints, I'm perfectly happy here'. One relative we spoke with described the home as 'One big family'. They told us they were relieved knowing their loved one was cared for at the home, noting 'I can sleep at nights now'.

We observed people were involved in choosing their meals and activities. People told us staff listened to them. Activities and objects of reference within the home were provided to reduce agitation, and promote wellbeing, independence and reminiscence. Activities included word games, social gatherings and discussions. Reminiscence objects included a sewing machine, records and gramophone from a period of time relevant to people's memories, placed around the home to encourage discussion.

Is the service responsive?

We saw people's needs were assessed on admission to the home. Care plans were reviewed regularly to meet people's changing needs. Relatives helped staff to understand people's history as well as their current needs. This meant staff could provide support and encouragement safely, and within a context the person understood.

People were supported to socialise outside the home as well as with those on other units within the home. Activities were varied to promote interaction throughout the home and local community. Relatives were encouraged to visit and participate in planned activities.

Is the service safe?

People told us they felt safe with staff. We saw the provider had a 'safeguarding vulnerable adults' policy that explained the process of identifying safeguarding concerns. It noted how these should be raised with the provider and other agencies, such as the local safeguarding authority. Staff understood the process to follow.

Potential risks were identified and assessed. Actions were in place to reduce the risk of harm to people, staff and others. Risk assessments were reviewed to ensure risks were reduced. We saw care plans recognised risks specific to individuals, such as falling or insufficient nutritional intake. Staff were guided to promote actions to reduce risks, such as encouraging people's use of walking aids, and weighing people regularly to monitor their weight gain or loss.

The home was well maintained and appropriate for the needs of the people who lived there. Staff conducted regular checks, such as weekly water temperature checks and fire alarm tests, to ensure the home was maintained safely. External contractors carried out services in accordance with the manufacturers' guidance. For example, we saw the gas boiler was serviced annually, and an asbestos register informed contractors of safe working practice around areas of asbestos within the home. This ensured people were protected from risks associated with a poorly maintained environment.

Is the service effective?

One person we spoke with told us 'Staff are very supportive, they always talk with us'. We observed staff supported people in line with their care plan. Staff told us they knew and understood the people they supported as they worked with them regularly. This helped staff learn the most effective way to support people's needs and wellbeing.

Care plans recorded people's needs and wishes. Information was reviewed and updated regularly. We observed a staff handover meeting. Communication was effective, ensuring staff understood people's current health and support needs. Visits from health providers, such as the GP and district nurse, were recorded to ensure any required follow up, such as dressing changes or medication alterations, was provided.

Is the service well led?

Feedback was gathered from people through informal chats with staff, monthly resident meetings and an annual survey of people and their relatives. People told us they could influence the home, for example through menu and activity choice. Minutes from meetings showed changes made following requests from people, such as a fish and chip supper.

Staff told us they felt management listened to their comments. We saw comments from people, staff and visitors who had been invited to inform the planned redevelopment of part of the home. Staff said they were excited about the plans.

The manager and provider conducted monthly and quarterly audits to monitor the quality of care provided. Where issues were identified we saw an action plan recorded actions required and progress towards completion. For example, when it was identified that staff required fire training, fire drills were planned, delivered and evaluated to assess learning.

People told us staff respected their individual choice and opinions. They told us they were encouraged to remain as independent as possible and to say how they wished to be cared for. They said the staff made time to listen and support them appropriately.

We saw care plans were comprehensive and reflected people's needs, preferences and diversity. People told us they experienced safe and appropriate care that met their needs and protected their rights. All risks to people's safety were assessed and there were management systems in place to reduce the likelihood of occurrence.

We observed staff were trained and professional. They had been recruited appropriately to keep people safe from harm. Staff told us they were appropriately supported and had opportunities to further their skills and knowledge by attending regular training sessions.

The service monitored its own performance and regularly sought the views of people using the service.