West Lodge Care Home

West Lodge is a care home providing accommodation for people who require nursing or personal care in one adapted building. The service provides support to adults over 65 years who may have dementia or physical disabilities. The service can accommodate a maximum of 27 service users. At the time of our inspection there were 18 people using the service.

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

There was a lack of consistency in how the service was managed and led. There were no clear roles and responsibilities for staff who were managing the service.

People were not always protected against avoidable harm. When people’s needs changed, responses were slow in ensuring people had appropriate support. Some care records did not accurately reflect risks to people or how these were managed.

People were not supported to have maximum choice and control of their lives. The systems in place did not always mean people were supported in the least restrictive way and in their best interests.

People had access to health care professionals. The management team were building relationships with local health professionals and where necessary, made referrals for additional advice and support.

Staff were recruited safely, and staffing levels were sufficient to support people's needs. Staff had received training that was appropriate to their role.

Following our feedback, the provider began to address our concerns demonstrating their commitment to improving the standard of care delivered to people.

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 6 August 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, consent and good governance at this inspection.

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 following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

West Lodge Care Home provides accommodation, nursing and personal care for up to 27 older people, some of whom are living with dementia. At the time of our inspection 15 people were living in the home. The home has three floors. People have a choice of two communal lounges, a dining room and a conservatory.

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

There were shortfalls in the way the service was led. There were two breaches of the Health and Social Care Act 2008 (Regulations) 2014. The systems to monitor the quality of the home were not always effective. The provider's quality assurance systems had not been effective in identifying all areas that required improvement.

The potential concerns identified at the last inspection, regarding people’s consent had not been fully addressed. We identified that some people were at risk of their dignity and privacy not always being maintained.

Risks to people were assessed however they were not always safely monitored and managed. There were policies and guidance in place, however staff did not always follow them. This put people at risk of harm.

There were sufficient numbers of staff to support people, however effective arrangements were not always in place to make sure that staff had completed all relevant training to meet people’s individual health needs.

Peoples end of life needs, including pain and symptom management were assessed and care plans were in place, however they were not always detailed.

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

There were systems and processes in place to safeguard people from abuse.

People received their medicines as prescribed and supported people in a person-centred way which maintained their dignity.

People were provided with food and drinks which met their needs and cultural preferences.

At the time of inspection, the service was undergoing some improvements to the building to enhance the service design and decoration to further meet people’s needs.

People were supported people to live healthy lives and access healthcare services when needed.

People were treated in a kind and caring way and were happy with the support they received from staff. They and their relatives were involved with reviewing their care.

People were encouraged to be independent and make choices on how to spend their day. People were supported to maintain their preferences related to their ethnicity, language, culture and religious beliefs.

There were activities provided to people who enjoyed them. People were supported people to maintain relationships with their loved ones.

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 Good (published 19 February 2019 ). This was under its previous provider.

Why we inspected

The inspection was prompted in part due to concerns received about poor management of people’s end of life care needs, tissue viability and pain management. The decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe and well- led sections 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.

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 breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this 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 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.

We found the following examples of good practice.

¿ The service had placed a shed in the garden where staff and visitors could perform COVID-19 testing and apply personal protective equipment (PPE) before entering the building.

¿ On entering, temperature checks were performed in reception. There were signs to explain the use of PPE, further PPE supplies and a clinical bin for waste disposal.

¿ Visitors could sit in the garden to see their relatives through the conservatory windows.

¿ Internal visits were restricted to only see people who were at the end of their life and relatives followed the same infection control procedures that staff did.

¿ While visiting was restricted, people were kept in touch with relatives using phone calls and social media. Families had all been sent a letter about the visiting restrictions in the post.

¿ Furniture had been rearranged to encourage social distancing in communal areas. Staff went on breaks one at a time and handover were distanced using a large dining area.

¿ During the outbreak the service had used agency staff. Staff were blocked booked to minimise changes of staff and agency profiles were obtained to ensure staff had the skills required.

¿ When people were isolated in their rooms, staff were allocated to work in certain areas and the home was zone into positive and negative COVID-19 areas.

¿ People in isolation had their doors closed, and PPE stations outside their rooms to reduce the risk of cross infection.

¿ New admissions to the service were asked to self-isolate isolation for 14 days to prevent cross infection.

¿ Policies and procedures were up to-date and staff had training in infection control, handwashing and applying and removing PPE. The registered manager performed supervision sessions to discuss recent changes in guidelines.

¿ There was a testing schedule in place for staff and people living at the service. Staff performed checks on people’s temperature and oxygen saturation three times a day to detect any change in condition.