This unannounced inspection took place on 03 and 09 May 2018. Stanley Lodge is registered with the Care Quality Commission to provide accommodation and personal care for up to 23 residents. The home is situated in a rural area of Forton near Lancaster.
Stanley Lodge Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
We last carried out a comprehensive inspection at Stanley Lodge Residential Home in May 2016. The home was rated good but we identified some concerns in relation to the environment. We carried out a focussed inspection in January 2017 to check improvements had been made. We found the registered provider had made the improvements required.
At this inspection visit carried out in May 2018, we found the registered provider had not met the fundamental standards. We identified concerns in relation to premises and equipment, person centred care, staff training and good governance.
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.
At this inspection visit carried out in May 2018, we found the home environment was not always appropriately maintained. We found areas within the home which were in need of repair. For example, two toilets were out of use, only one bathroom was in use, two bedroom windows were secured with tape and a hole in a ceiling had been temporary boarded over but not repaired. This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) 2014.
Because of the poor maintenance of the home, people were sometimes unable to have a bath when they requested it. This meant people’s preferences and wishes were not always met. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) 2014.
Staff did not always receive ongoing training and support to ensure them to carry out their roles safely. For example, only three staff who worked at the home had an up to date qualification in basic first aid. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) 2014.
Paperwork was not always suitably completed in order to ensure safe and effective care was delivered. We found paperwork was not always up to date and accurate. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.
Although people told us they felt safe we found risk was not always appropriately addressed and managed in a timely manner. We have made a recommendation about this.
Processes were in place to ensure medicines were suitably and safely managed in line with good practice guidance. However, we found these were not consistently embedded. We have made a recommendation about this.
On the first day of the inspection visit the registered manager told us they had recently introduced an electronic care recording system. They said however they had not had time to fully implement the system so staff were using two different care recording systems. We reviewed care records and found paperwork was disorganised and care records did not always reflect people’s needs. We fed this back to the registered manager who took immediate action. On the second day we were informed by the registered manager they had decided to revert to their original care recording system. They said they had taken immediate action and had reviewed all care records. We have made a recommendation about this.
During the inspection visit we were made aware the registered provider was having difficulties in recruiting staff. After the inspection visit we received assurances from the registered manager that action had been taken and improvements had been made to increase the number of available to work.
We saw evidence of multi-agency working to promote effective care. Health professionals praised the skills and knowledge of staff who worked at the home. Relatives told us the home was good at meeting the needs of people.
People, relatives and professionals told us there were enough staff on duty to meet individual needs. We observed staff encouraging and supporting people to take part in activities during our inspection visit.
People who lived at the home and relatives praised the caring and helpful nature of staff. From observations we saw staff were patient and respectful with people.
People and relatives told us that people’s nutritional needs were met by the registered provider. We observed meals being provided and noted there was sufficient quantities of food and flexible choice for people.
Systems were in place to safeguard people from abuse. Staff were able to identify types of abuse and how to report any concerns.
We reviewed infection prevention and control processes at the home. We identified some areas for improvement and made a referral to the infection prevention and control team so staff could access up to date professional advice to ensure infection prevention control processes at the home were consistent.
People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.
Consent to care and treatment was routinely sought. People had freedom to mobilise throughout the building.
Staff who worked at the home described it as a good place to work. They praised the skills of the registered manager and said the home was well-led. People and their relatives told us they also considered the service to be well led.
The registered provider liaised with health professionals when people required end of life care at the home to ensure people received care in line with good practice.
We looked at how complaints were managed and addressed by the registered provider. At the time of the inspection no one had any complaints about how the service was delivered. We were told by relatives the manager was approachable and would take time out to listen to any concerns they may have. Feedback from relatives about the home and how it was managed was positive.
Following the inspection visit we made a referral to the Local Authority Infection Prevention and Control Team and spoke with the Fire and Rescue service to provide feedback from our findings. Both the infection prevention and control team and fire and rescue service visited the home and carried out inspections in response to information shared.
This is the first time the service has been rated Requires Improvement.
You can see what action we told the provider to take at the back of the full version of the report.