Godden Lodge Care Home

Godden Lodge Care Home is a residential care home providing personal and nursing care for people aged 65 and over. Some people have dementia related needs and other people require palliative and end of life care. The service consists of 4 houses: Victoria House, Cephas House, Boyce House and Murrelle House. At the time of inspection Murrelle House was not operational. The service can support up to 133 people and at the time of our inspection there were 60 people living at the service.

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

Suitable arrangements were in place to keep people safe. Policies and procedures were followed by staff to safeguard people and staff understood these procedures. Risks to people were identified and managed to prevent people from receiving unsafe care and support. Medicine arrangements ensured people received their prescribed medication and staff’s practice was safe. Although there were mixed comments from relatives about staffing levels, during the inspection we found the service to be appropriately staffed to meet people’s care and support needs. Recruitment practices were safe to ensure the right staff were employed to care for vulnerable individuals. People were protected by the provider's arrangements for the prevention and control of infection. Arrangements were in place for learning and making improvements.

Staff received appropriate training opportunities. Suitable arrangements were in place for staff to receive a robust induction and regular formal supervision. The dining experience was positive, and people's nutritional and hydration needs were met. The service ensured people received appropriate healthcare support as and when needed from a variety of professional healthcare services. Improvements had been made to the environment. The service worked together with other organisations to ensure people received coordinated care and support. 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.

People were treated with care, kindness, dignity, and respect. People received care and support that met their needs and preferences. Staff had a good knowledge and understanding of people's specific care and support needs and how they wished to be cared for and supported. The rapport between staff and people using the service was positive. Individuals had a support plan in place describing their specific care and support needs; and the delivery of care to be provided by staff.

People’s social care needs were met. Complaints were investigated and managed. Robust arrangements were in place to assess and monitor the quality of the service provided. Relatives and staff were complimentary regarding the new manager.

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 Inadequate (published March 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the provider seek independent advice and guidance to improve the service’s staff training arrangements and ensure the premises are suitable to meet people’s needs. At this inspection we found the provider had acted on these recommendations and improvements had been made.

This service has been in Special Measures since 17 March 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Follow up

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

Godden Lodge Care Home is a residential care home providing personal and nursing care for people aged 65 and over. Some people have dementia related needs and other people require palliative and end of life care. The service consists of 4 houses: Victoria House, Cephas House, Boyce House and Murrelle House. At the time of inspection Murrelle House was not operational. The service can support up to 133 people and at the time of our inspection there were 77 people living at the service.

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

The delivery of care for people was not always safe. Information relating to people's individual risks was not always recorded or did not provide enough assurance that people were safe. Suitable arrangements were not in place to ensure the proper and safe use of medicines. The staffing levels and the deployment of staff was not suitable to meet people's care and support needs.

Lessons were not learned, and improvements made when things went wrong. Staffs' training was not embedded in their everyday practice. We have made a recommendation about staff training.

Not all staff felt supported or valued by the management team. People at risk of poor nutrition and hydration were not properly and accurately assessed and we could not be assured if people’s hydration needs were being met. We have made a recommendation about people’s fluid intake. The premises did not meet people's needs, particularly for people living with dementia. We have made a recommendation about this.

People and their relatives told us they were treated with care and kindness. However, the care provided was not always caring or person-centred. This was attributed to inadequate staffing levels and poor deployment of staff, high agency staff usage and the impact this placed on the quality of care people received. Many interactions by staff remained task and routine led. People were not always treated with dignity and respect.

Not all care plans contained enough information to ensure staff knew how to deliver appropriate person-centred care and treatment based on people's needs and preferences. Where information was recorded this was not always accurate or up to date. People were not supported or enabled to take part in regular social activities that met their needs.

The leadership, management and governance arrangements did not provide assurance the service was well-led, that people were safe, and their care and support needs could be met. There was a lack of understanding of the risks and issues and the potential impact on people using the service.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service worked with other organisations to ensure they delivered joined-up care and support and people had access to healthcare services when needed. People were protected by the prevention and control of infection. Staff had received an induction and formal supervision.

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 Requires Improvement [Published April 2021]

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

The overall rating for the service has changed from Requires Improvement to Inadequate based on the findings of this inspection.

Enforcement

We have identified breaches in relation to risk and medicines management, staffing, care planning, person-centred care and quality assurance 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Godden Lodge Care Home is a residential care home providing personal and nursing care for people aged 65 and over. Some people have dementia related needs and other people require palliative and end of life care. The service consists of three houses: Victoria House, Cephas House and Murrelle House. The service can support up to 133 people and at the time of our inspection there were 44 people living at the service.

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

The leadership, management and governance arrangements provided significant assurance to suggest the service was being managed well. Quality assurance and governance arrangements at the service had improved since our last inspection in December 2019. However, progress made needs to be sustained and maintained over the longer term.

Improvements were needed to demonstrate how the service’s staffing levels are determined. Food and fluid records needed to record if a person’s diet was satisfactory. Improvements were still required to ensure all people using the service are given opportunities for social stimulation.

Risks were identified and recorded, and medicines management was safe. People told us they were safe and suitable arrangements were in place to protect people from abuse. Staff understood how to raise concerns and knew what to do to safeguard people. People were protected by the services prevention and control of infection practices. Lessons were learned and improvements made when things went wrong.

Staff received mandatory and specialist training. Staff felt valued and supported by the management team and received regular supervision. The dining experience for people was good and people received enough food and drink of their choice to meet their needs. People were supported to access healthcare services and receive ongoing healthcare support. The service worked with other organisations to enable people to receive effective care and support. 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.

People and those acting on their behalf told us they were treated with care, kindness, respect and dignity. Staff had a good rapport and relationship with the people they supported, and observations demonstrated people received a good level of care.

People’s care and support needs were documented in an individual plan. Staff had a good understanding and knowledge of people’s needs and the care to be delivered. Improvements were required to enable people to participate in meaningful social activities to meet their needs. Complaints were well managed and a record of compliments to capture the service’s achievements was maintained.

We have made recommendations about staffing levels, food and fluid records and social activities.

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 Inadequate (published 4 March 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since March 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Godden Lodge is a residential care home providing personal and nursing care for people aged 65 and over. Some people have dementia related needs and some people require palliative and end of life care. The service consists of four houses: Victoria House, Cephas House, Boyce House and Murrelle House. The service can support up to 133 people and at the time of our inspection there were 87 people living at the service.

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

Information relating to people’s individual risks was not always recorded or did not provide enough assurance that people were safe. Suitable arrangements were not in place to ensure the proper and safe use of medicines. The incidence of medication errors at the service were high. Not all medication errors had been investigated and where these had been investigated, they were not as thorough as they should be.

Required recruitment checks on staff were not robust enough to ensure staff were suitable to work at the service. This referred specifically to agency staff used at the service. Lessons were not learned, and improvements were not made when things went wrong.

People were protected by the prevention and control of infection but where stringent infection control measures were required for specific people, information was not recorded within their care plan.

Not all staff employed at the service had received mandatory or refresher training. Not all agency staff working at the service [Boyce and Murrelle Houses] had received or completed an ‘orientation’ induction when undertaking their first shift at the service. Where staff had been promoted to a more senior role, there was no evidence of an induction having been completed. Staff had received regular formal supervision. Not all staff spoken with felt supported or valued by the organisation or management team.

Where people were moved from one house to another house, people and those acting on their behalf confirmed they had not always been consulted, given enough notice or provided with a rationale for the transfer. People were not supported to have maximum choice and control of their lives. Best interest decisions were not always recorded where people had bedrails in place or a sensor alarm fitted to alert staff if they got out of bed and mobilised within their room.

People’s comments about the food they received was variable. People at risk of poor nutrition and hydration were not properly and accurately assessed. People’s nutritional and hydration needs were not properly monitored and recorded to ensure unnecessary dehydration.

Although the service worked with other organisations to ensure they delivered joined-up care and support, records suggested people did not always have access to healthcare services when needed. No-one spoken with had seen their own or their family member’s care plan. Relatives did not know what information was available for them to access.

People did not always feel they were treated with care and kindness or feel listened too. People’s comments about the level of care they received was variable across the service. This was attributed to inadequate staffing levels, staff regularly being moved between the individual house’s, high usage of agency staff and staff not having the time to spend with them. Many interactions by staff remained task and routine led.

Not all care plans contained enough information to ensure staff knew how to deliver appropriate person-centred care and treatment based on people’s needs and preferences. Where information was recorded relating to specific incidents, evidence of staff interventions to demonstrate the support provided and outcomes was not always recorded or appropriate. End of life care plans were in place but provided limited information to guide staff on how to provide care to a person who was at the end stages of their life.

People were not supported or enabled to take part in regular social activities that met their needs. Arrangements were in place to record, investigate and respond to any complaints raised with the service. However, there was a lack of evidence to demonstrate lessons learned and learning outcomes.

The leadership, management and governance arrangements did not provide assurance that the service was well-led, that people were safe, and their care and support needs could be met. Quality assurance and governance arrangements at the service were not reliable or effective in identifying shortfalls in the service. There was a lack of understanding of the risks and issues and the potential impact on people using the service. The lack of effective oversight of the service has resulted in continued breaches of regulatory requirements.

Rating at last inspection

The inspection was prompted in part by notification of a specific incident due to concerns received about the care people using the service received. The Care Quality Commission were also aware that the Local Authority had on-going concerns about the service. A decision was made for us to inspect and examine those risks and we found significant improvements were required.

The rating at last inspection was requires improvement (published June 2019). There were three breaches of regulation. These related to breaches of Regulation 12 [Safe care and treatment], Regulation 17 [Good governance] and Regulation 18 [Staffing].

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider and request an action plan to understand what they will do to improve the standards of quality and safety. We will work alongside the provider, Local Authority and CCG to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

Godden Lodge Care Home provides accommodation, personal care and nursing care for up to 133 older people. Some people have dementia related needs and some people require palliative and end of life care. The service consists of four houses: Victoria House, Cephas House, Boyce House and Murrelle House.

People’s experience of using this service:

Not all people felt well cared for or treated with dignity and respect. Staff routines and preferences took priority over consistent care and meeting people’s preferences and wishes.

People were not routinely supported to take part in social activities, relevant to their interests, preferences or needs. There were insufficient activity coordinators available to facilitate activities.

People’s comments about staffing levels were variable. The service did not always ensure there were enough staff with the right skills and experience to support people. This was because there was high agency usage across the service. Staff did not always have the time to give people the care and support they needed. Staff regularly felt stretched, and the focus was on completing tasks rather than on providing person-centred care and support.

Information about risks to people’s safety was not consistently identified and recorded. Some staff practices placed people at potential risk of harm. Medicine practices did not ensure the service followed relevant national guidelines. People did not always receive their medicines as prescribed.

People were not always protected by the service’s prevention and control of infection procedures as the premises were not as clean and hygienic as they should be.

Staff training was not designed around the care and support needs of people who use the service. Training was not embedded in staff’s everyday practice. Staff supervision and support was not consistent, and improvements were required.

• Care records were not always accurate, up-to-date or followed by staff. People were not always involved in decisions about their care and support. People’s end of life care needs were not clearly documented.

People stated they were safe and supported to eat and drink enough. People’s healthcare needs were monitored, and they received access to healthcare services. Consent to care was always sought and people’s capacity to make decisions assessed.

People, relatives and staff did not feel the service was always well-led. Governance and performance management arrangements were not always reliable or effective.

Rating at last inspection:

Following the last inspection, the rating of the service was ‘Good’ (Last report published October 2017).

Why we inspected:

This was a planned inspection based on the rating at the last inspection of ‘Good’.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as outlined in our inspection programme and schedule. If any concerning information is received we may inspect sooner.

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

Godden Lodge Care Home provides accommodation, personal care and nursing care for up to 133 older people. Some people have dementia related needs and some people require palliative and end of life care. The service consists of four houses: Victoria House, Cephas House, Boyce House and Murrelle House. At the time of this inspection there were 98 people living at the service and across the site.

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 2008 and associated Regulations about how the service is run.

People told us the service was a safe place to live. Although people’s comments about staffing levels were variable, the deployment of staff was generally seen to be appropriate. However, improvements were needed to ensure that staffing levels were reviewed and staffs practice was person-centred rather than service-led.

Systems were in place which safeguarded people from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to. Staff followed safe procedures when giving people their medicines. Appropriate arrangements were in place to recruit staff safely so as to ensure they were the right people.

Care records for people centred on the individual and provided sufficient information relating to their care and support needs and how these were to be delivered by staff. Relatives confirmed they were given the opportunity to be involved in the assessment and planning of their family member’s care. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed. Staff demonstrated a good understanding and knowledge of people’s specific support needs, so as to ensure theirs’ and others’ safety.

Staff understood and had a good knowledge of the Deprivation of Liberty Safeguards [DoLS] and the key requirements of the Mental Capacity Act [2005]. Arrangements had been made to ensure that people’s rights and freedoms were not restricted. People were routinely asked to give their consent to their care, treatment and support. People’s capacity to make day-to-day decisions had been considered, assessed and respected?

The dining experience for people was positive. Consideration by staff had been given to ensure that eating and drinking was an important part of people’s daily life and treated as a social occasion. People’s healthcare needs were managed well and relatives confirmed they were kept up to date with interventions and outcomes for their member of family. People received care and support that was kind and caring. People were mostly treated with respect and dignity.

Quality assurance checks and audits carried out by the registered provider and the management team of the service were in place and had been completed at regular intervals in line with the provider’s schedule of completion. The registered provider and management team of the service were able to demonstrate an understanding and awareness of the importance of having good quality assurance processes in place. Feedback from people using the service, those acting on their behalf and staff were positive about the overall management of the service, stating that the management team were approachable and there was an open culture in the service.