Skylark House

Skylark House is a residential care home providing personal and nursing care for up to 82 people in purpose-built accommodation. The service provides support to older people, many of whom have dementia, and younger people with disabilities. At the time of our inspection there were 75 people using the service.

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

People were not all receiving the social stimulation they needed to support their well-being, we identified this as a breach of regulation. The provider’s systems for monitoring quality had not identified this shortfall. People, their relatives and staff were consistent in their feedback that staff were often too busy to spend meaningful time with people unless it was to provide support with personal care. The registered manager described planned improvements for people’s social support.

People were supported to plan for end of life care. Staff were knowledgeable about people’s needs and systems were in place to ensure people received the medicines and care they needed to manage symptoms effectively.

There were enough suitable staff to care for people safely. There was an ongoing recruitment programme to ensure vacant posts were filled with regular staff. People spoke highly of the staff and described them as kind and caring. A person told us, “I think the staff are wonderful and I can’t praise them highly enough.”

Risks to people were assessed and managed safely. People received their medicines as prescribed and when they needed 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.

Care plans reflected people’s needs and were updated regularly and when their needs changed, including end of life care plans. Complaints and concerns were acted upon to make improvements. The registered manager described a learning culture saying, “If we get things wrong, we must apologise and learn from our mistakes, there’s no point in being defensive, it’s better to be open and make improvements.”

People, their relatives and staff were consistent in their praise of the management of the service. One person told us, “There is a lot to manage and it all runs well.”

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 5 April 2018).

Why we inspected

The inspection was prompted in part due to concerns received about end of life care. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern. We did find other areas of practice that required improvement. Please see the responsive section of this full report.

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

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

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.

We found the following examples of good practice.

The registered manager had followed current guidance in relation to infection prevention and control (IPC). The service had an IPC champion who ensured staff maintained effective IPC measures and accessed current guidance.

The provider had implemented COVID-19 policies and procedures. Staff had been kept updated by regular alerts through a messaging service and daily meetings, this ensured staff were aware of any changes to guidance or peoples’ needs.

The home had been impacted by an outbreak of COVID 19. Staff monitored people's physical health twice a day, this included their temperatures and oxygen readings. At the time of the inspection some people were still isolating in their rooms due to testing positive for COVID-19. People who had completed their period of isolation were able to access communal areas if they wished.

The registered manager and staff had shown resilience and had managed the impact of COVID-19 well throughout the outbreak, staff covered shortfalls in the rota to ensure people received continuity of care.

The registered manager ensured people received support to maintain contact with loved ones during the outbreak and ensured any essential visits to the home were managed safely.

All staff had received the COVID-19 vaccination. The service had a system to record all staff and visiting professionals’ COVID-19 vaccination status in line with guidance.

The registered manager had implemented enhanced cleaning schedules to incorporate regular cleaning of high touch areas and additional deep cleaning.

The registered manager and IPC lead attended meetings within the organisation where learning was shared and applied within the service.

A registered manager was 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.

We have made a recommendation about systems being implemented to comply with the Accessible Information Standards (AIS).

Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were happy and relaxed with staff. They said they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector.

Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff.

Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of equality, diversity and human rights.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with dementia and palliative care (end of life). Staff had received both supervision meetings with their manager, and formal personal development plans, such as annual appraisals were in place.

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. Health care was accessible for people and appointments were made for regular check-ups as needed.

People felt well looked after and supported. We observed friendly relationships had developed between people and staff. Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People’s end of life care was discussed and planned and their wishes had been respected.

People chose how to spend their day and they took part in activities. They enjoyed the activities, which included one to one time scheduled for people in their rooms, bingo, exercise, quizzes, massage and manicures, film nights in the cinema and bar area and themed events, such as reminiscence sessions and visits from external entertainers People were also encouraged to stay in touch with their families and receive visitors.

People were encouraged to express their views and had completed surveys. They also said they felt listened to and any concerns or issues they raised were addressed. Technology was used to assist people’s care provision. People's individual needs were met by the adaptation of the premises.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement.