Cleaveland Lodge

Cleaveland Lodge provides accommodation and personal care for up to 54 older people, some of whom may be living with dementia. At the time of the inspection 35 people were living in the service.

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

People told us they were happy living at the service and the with the support they received. One person told us, “I have everything I need.”

Since our last inspection the previous registered manager had gone back into post. The provider had worked with the registered manager and local authority quality team to embed improvements at the service.

Care and treatment were planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. Staff had received the appropriate training. There were systems in place to minimise the risk of infection and to learn lessons from accidents and incidents. Medication was dispensed by staff who had received training to do so.

The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. 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 support this practice.

People were supported to eat and drink enough to ensure they maintained a balanced diet and referrals to other health professionals were made when required. The environment was well maintained and suitable for people.

People and their relatives and advocates were involved in the planning and review of their care. People were supported to follow their interests and participate in social activities. The registered manager responded to complaints received in a timely manner. People were supported to make plans for the end of their life.

The registered manager had been successful in driving improvements at the service. Systems had been put in place to monitor the service and improve outcomes for people.

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 11 November 2020). 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 11 November 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. The overall rating for the service has changed from Inadequate to Good. This is based on the findings at this inspection.

Why we inspected

We undertook this inspection to check the provider had followed their action plan and to confirm they now met legal requirements.

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.

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

Follow up

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.

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

We found continued shortfalls in the oversight and governance of the service. A chaotic culture of leadership scrutiny failed to identify significant shortfalls in the management of the service. These failings placed people using the service at risk of harm, and significant exposure to the risk of harm.

The registered manger resigned in March 2020 but continued to work as part of the management team on a part time basis. A new manager was appointed in April 2020 but had yet to register with the Commission. The provider’s systems for identifying, capturing and managing risks to people’s health, welfare and safety remain ineffective.

Risks to people’s health, welfare and safety had not always been identified with action taken to reduce the risk of harm. Audits did not identify the shortfalls found as part of this inspection and there continued to be no effective quality and safety monitoring in place to drive improvements.

We were not assured the provider was doing all that was practical to ensure Covid-19 outbreaks would be prevented. The service was not consistently following the Government guidance, about how to operate safely during the Covid-19 pandemic, in areas such as the wearing of personal protective equipment (PPE), social distancing and ensure staff were provided with designated areas for putting on and taking off their PPE.

People's medicines were generally managed well, however not everyone prescribed as and when needed medicines, had a protocol in place to guide staff in monitoring their use. Previous inspections identified the need to implement a pain assessment tool for staff to identify and respond to people who lacked capacity to verbally express if in pain. Whilst a monitoring tool had been put in place staff had not been trained in its use and so it remained ineffective.

We recommended further work was needed to consider safeguarding risks and provide procedural guidance for staff where staff who were related or living in the same household worked on the same shift.

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 7 February 2020].

At our last inspections in July 2019 and January 2020, we found shortfalls in the management of risk to people’s safety. There was continued failure to robustly assess risks relating to the health safety and welfare of people. We found continued breaches of regulation 12 [Safe Care and Treatment] of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014 and Regulation 17 [Good governance] of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

The inspection was prompted in part due to concerns received about unwitnessed falls and the provider's arrangements for falls management, care and support for people with a catheter and inadequate staffing levels. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of 'Safe', ‘Caring’ and 'Well-Led' only.

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

Enforcement

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 have identified continued breaches in relation to safe care and treatment, recruitment, governance and failure to notify. Immediately after the inspection we wrote to the provider and requested they provide us with urgent information telling us what they were going to do regarding safe care, the management of risks, infection control and ineffective government arrangements.

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 work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

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 means 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 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.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

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

Risks were not always assessed or managed effectively to reduce the risks of harm. We identified concerns with regards to how the service was managing the risks associated with falls and people’s dietary needs.

Improvements had been made to the oversight of environmental risks and regular checks were being undertaken on equipment and the building to check that the systems were working effectively.

Infection control procedures were not always followed and put people at risk of harm. While there were some audits on infection control these need further development.

Quality assurance was not well developed and the systems in place to monitor the quality of the service were not effective. The registered manager was in the process of developing an audit tool which they could use to audit areas such as care plans, but this was not yet implemented.

Staff demonstrated a better understanding of safeguarding procedures and appropriate referrals had been made. We have made a recommendation about safeguarding.

On the day we inspected there were enough staff available to meet people’s needs although the provider had brought in additional staff to support people over lunchtime. We have made a recommendation about the deployment of staff at night. Checks on staff suitability were undertaken prior to their employment.

Medicines were securely stored and administered in line with best practice. We made a recommendation about developing pain management tools.

Staff were caring in their approach and work was underway to update care plans and provide a more person-centred service. The registered manager had started to engage with the local authority quality team and other organisations to drive improvement.

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 requires improvement (published 26 July 2019). Following the last inspection, we did not receive an action plan, but we met with the registered manager to discuss what we found and their plans to make improvement.

Why we inspected

We received concerns in relation to the management of risks such as falls at the service. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. The provider needs to make improvement and 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 Cleaveland Lodge on our website at www.cqc.org.uk.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Why we inspected: This was a planned inspection based on the rating at the last inspection. We were also aware of a notifiable incident which was being investigated by the safeguarding team at the time of this inspection which raised questions about the care of people who were at risk of pressure ulcers.

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

Risks were not always assessed or managed effectively to reduce the risks of harm. We have required the provider to address this. There were limited use of systems to record and report safety concerns and near misses. Where people had fallen, technology was not being used to promote their independence and reduce risk.

Oversight systems and audits were not effective as these checks had not prevented some of the shortfalls in the quality of service provision. We have required the provider to address this.

Safeguarding processes were not working effectively, and incidents were not always recognised as safeguarding or subject to sufficient levels of scrutiny.

Pre-admission assessments were not sufficiently robust, and issues had not always been clarified or translated into the care plan. We saw that some people had moved into the service but subsequently left because the service was not able to meet their needs. We have made a recommendation about the assessment processes.

There were sufficient staff available to support people and staff were accessible and visible. Staff knew people well and had good relationships with people.

There was a low turnover of staff and shortfalls in staffing were covered within the staff team. Checks were undertaken on staff prior to them commencing employment but we have recommended that the recruitment checks are more robust.

Peoples medicines were managed safely

Staff were provided with training to develop their skills and knowledge. However, staff practice in areas such as catheter care did not always follow the recommended guidelines. Additional training on pressure care was planned but we have recommended that training is provided to staff on catheter care.

People were positive about the meals provided and we saw that the food served looked appetising and was well received.

The systems in place to monitor people health and support needs was not fully effective. Peoples nutritional needs were identified but the ongoing monitoring of those at risk needs to be more robust.

People had care plans in place to guide staff on people’s preferences and how to support people. However, information was not always up to date or sufficiently detailed which meant that people were at risk of not having their needs met in a safe and effective way. We have made a recommendation about care planning and developing plans for people at the end of their life.

People had access to some social activities, but the feedback was inconsistent, and people would benefit from a wider range of opportunities. We have made a recommendation about this.

People and relatives were happy with the care provided and spoke positively about the leadership of the service.

The provider encouraged feedback from people and we saw that they acted when issues were identified.

The mental capacity act was not fully understood by staff or implemented. People were not supported to have maximum choice and control of their lives. 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. We have made a recommendation about this.

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 02 December 2016.)

We have found evidence that the provider needs to make improvements. The provider has taken some steps to mitigate the risks and 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 Cleaveland Lodge on our website at www.cqc.org.uk.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cleaveland Lodge provides accommodation and care for up to 54 older people some of whom may be living with dementia. On the day of our inspection there were 52 people living in the service.

There was a registered manager in place. 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.

Checks were undertaken on staff suitability for the role for which they were employed but records were not maintained of interviews and we could not be assured that the checks were sufficiently robust.

Staff were visible and assessable and there were sufficient numbers of staff available to meet the needs of the people living in the service. Staff received an induction to prepare them for their role and additional training was provided to support their learning and development.

Medication was generally managed safely but we did find inconsistencies in the recording systems which need to be resolved to ensure a robust and accountable system.

People were offered a varied diet and could have alternatives to the menu if they chose. Where necessary, staff assisted people with eating and drinking. Systems were in place for staff to monitor people's nutrition and hydration with action being taking when concerns were identified. Staff ensured that people's health needs were effectively monitored. They supported people to access a range of health care services to maintain and improve their health and wellbeing.

The registered manager and staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). MCA and DoLS are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals. People's best interests had been considered when decisions that affected them were made. Applications for DoLS authorisations had been submitted where restrictions were in place. It was agreed that applications would be made for individuals on respite care where this was needed to keep them safe.

Relationships between people living in the service and staff were positive. Staff knew people well and were caring and kind. There were activities in place which people enjoyed and promoted their wellbeing. People were given choices in their daily routines and looked well groomed. There were systems in place to ensure that key information about people’s health and welfare were communicated between staff and families.

People expressed confidence their concerns would be listened to. There were systems in place to respond to complaints although most people told us that they had no cause to complain.

People and their relatives were complimentary of the care provided and how the service was managed. The manager and providers were assessable and actively involved in the day to day management of the service. Staff understood their role and were well supported. There were systems in place to ascertain people’s views and drive improvement.

Relatives of people who lived in the home spoke positively about the care provided and received by their loved ones, responses in surveys indicated that relatives felt that the home was well run and organised.