Archived: Chorley Lodge

Updated 18 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. This was a comprehensive inspection.

The inspection took place on 19 and 20 September 2018. The first day was unannounced. The inspection was carried out by one adult social care inspector, a bank inspector, a hospital inspector, a pharmacy inspector who specialised in medicines and one expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, we reviewed the information we held about the service, including previous inspection reports, complaints, safeguarding concerns and notifications we had received from the service. A notification is information about important events which the service is required to send us by law. We contacted healthcare and social care professionals who were involved with the service for their comments. We also contacted Lancashire County Council contracts team for feedback about the service.

We had not requested the provider to complete the Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

During the inspection, we spoke with ten people who lived at the home and five relatives. We also spoke with eight care staff, an activities co-ordinator, the manager, the regional manager, the chef, laundry staff and the administrator. We looked in detail at the care records of six people who lived at the service. We carried out an observation of the environment and interactions between people and staff. In addition, we looked at service records including staff recruitment, supervision and training records, policies and procedures, complaints and compliments records, audits of quality and safety, fire safety and environmental health records.

Updated 18 October 2018

We carried out an unannounced comprehensive inspection of Chorley Lodge on 19 and 20 September 2018.

Chorley Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 66 people. At the time of the visit there were 54 people who lived at the home.

Following our last inspection the registered provider Orchard Care Homes.com (4), was placed into administration. The administrator appointed another company to oversee the day to day running of the home. A new provider was in the process of applying to be registered with the CQC. The registered manager had left the service following our last inspection and a new manager had been appointed and was applying to register with the CQC. 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.

At the last focused inspection on 07 March 2018, we found five breaches of the regulations. This was because there were shortfalls to the safe management of people’s medicines. In addition, risks associated with receiving care including, nutrition and hydration had not been adequately managed and staff had not been adequately supported with supervision and ongoing training. The governance and quality assurance systems were not effective in identifying shortfalls to generate improvements to the quality of the service. These were breaches of regulation 12, 14, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following our last inspection of March 2018, we took enforcement action to impose conditions on the providers’ registration. We met with the provider to discuss what actions they intended to take to improve the quality of the care and addressed the shortfalls. We asked them to take immediate action to address the shortfalls and regularly submit evidence of their actions to CQC. We took enforcement action by adding conditions to the providers’ registration. The provider was also asked by the local authority’s contracts monitoring team to complete an action plan under their quality performance and improvement planning process.

During this inspection, we reviewed actions the provider told us they had taken to gain compliance against the breaches in regulations identified at the previous inspection in March 2018. We also looked to see if improvements had been made in respect of the breaches. We saw that significant work had taken place since our last inspection to improve the safety, effectiveness and quality of the service.

However, we found three breaches of the regulations of the Health and Social Care Act, 2008 (Regulated Activities) Regulations 2014. These were in relation to the management of risks to receiving care, good governance and failure to meet the conditions of their registration. We also made a recommendation in respect of mental capacity assessments. We also found that the work to improve the service was still in its early stages. Further improvements were required to ensure a consistent delivery of safe care and treatment that could be evidenced in the longer term. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals are concluded.

People who lived at the home told us that they felt safe in the home and that there was sufficient staff available to help them when they needed this. People and their visitors spoke highly of the care staff. They told us there had been improvements to the quality of care provided and that they were happy with the care and treatment.

Improvements had been made to the management of risks including risks associated with nutrition and hydration, medicines management and people experiencing frequent falls. Staff had closely monitored people to ensure they were having enough to eat and drink. However, we found shortfalls to the systems for reviewing risks levels and ensuring lessons learnt were shared in the service. Actions had been taken when people had experienced injuries however, accident and incident records had not always been overseen by the manager to check whether staff had taken appropriate action to support people. Some risk assessments we reviewed were generic and not specific to each person.

Management and governance systems in the home had improved however, this was at an early stage since the home had been placed in administration since May 2018. Further improvements were required to ensure that the new policies and procedures were fully established and embedded within the staff team and the governance systems in the home. The service had a new manager who had been in post for approximately three months. We noted an improvement in the systems designed to assess, monitor and improve the service. A significant number of audits and quality assurance processes were in place; they were supported by an action plan. However, the manager had not always followed up on delegated tasks to ensure they were completed to the standards required and within set time scales. We found a number of shortfalls which could have been picked up by robust audit systems. In addition, the provider had not effectively complied with the conditions set by CQC at the last inspection. The shortfalls we found indicated the quality assurance and auditing processes had not always been effective, as matters needing attention had not always been identified and/or addressed in a timely manner.

Records showed that staff had been recruited safely and the staff we spoke with understood how to protect people from abuse or the risk of abuse.

There had been improvements to staff training arrangements. Staff had received induction and appropriate training. People and their relatives felt that staff had adequate knowledge and skills to meet their needs effectively. Further improvements were required to ensure staff received regular supervision in line with the organisation's policy.

We observed people being supported in a sensitive and caring manner. People told us the staff who supported them were caring and respected their right to privacy and dignity. People told us staff encouraged them to be as independent as they could be.

There had been some improvements to the support people received with their nutrition and hydration. Actions had been taken to monitor people’s intake and to seek support where required. Improvements were still required to ensure the practices for monitoring and recording were consistent throughout the staff team. Referrals were made to community healthcare professionals where required to ensure that people received appropriate support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way. The service had taken appropriate action in line with the Mental Capacity Act 2005. However, further improvements were required to ensure capacity assessments were decision specific and best interest decisions were recorded. We made a recommendation about decision making and seeking consent.

People told us they received care that reflected their individual needs and preferences. Staff told us they knew people well and gave examples of people who required extra monitoring and their preferred routines. However, evidence we found showed people and their relatives were not always involved in the writing and reviewing of their care plans. This would ensure a person-centred approach to care planning.

We received mixed feedback regarding the caring approach of the staff from two relatives. However, the majority of the feedback we received in relation to the caring nature of staff was positive.

People were supported to take part in activities and events. They told us they were happy with the activities that were available at the home. We found the service had a policy on how people could raise complaints about care and treatment and improvements were required to demonstrate how complaints had been received and concluded.

Staff communicated effectively with people. They supported people sensitively and spoke to them at their level when providing care. People’s communication needs were identified, and appropriate support was provided.

The manager had sought feedback from people and their relatives about the support they received and shared with them improvement plans in the home.

People living at the service and staff told us they had noticed improvements in the management of the service and were happy with the leadership. They told us the new manager was approachable and supportive.

The manager had engaged with other health and social care stakeholders such as the local authority, Clinical Commissioning Groups and local health care professionals to improve the quality of care provided to people.

There was a business contingency plan to demonstrate how the provider had planned for unplanned eventualities which may have an impact on the delivery of regulated activities. The equipment and premises had been maintained and further renovations were in progress.

The provider had sent notifications to CQC for notifiable incidents, such as allegations and incidents of abuse and significant events that affected the smooth delivery of services.