Worcester Lodge

We found the following examples of good practice.

To minimise the risk of infection transmission, procedures were in place for staff and visitors on arrival to the service. This included wearing of personal protective equipment (PPE), checking vaccination status and the provision of a negative lateral flow test (LFT) result.

The providers visitor’s policy was in line with current guidance. Due to a COVID-19 outbreak at the service additional measures were currently in place around visiting. We signposted the provider in this area to ensure visiting guidance was adhered to after the outbreak and communicated to relevant people.

The service had appropriate donning and doffing areas and staff wore PPE in line with guidance. Staff had received training in infection control, including handwashing and how to use PPE.

Staff we spoke with were clear on procedures they should follow and were updated about changes by the registered manager. Staff were supported by the registered manager and provider throughout the pandemic.

Regular COVID19 testing was carried out for people, staff and essential care givers. Relatives we spoke with gave positive feedback about how the service had been managed through the pandemic and kept them informed.

Refurbishments at the home were enabling good infection control procedures to be implemented with the choices of furniture and décor. Cleaning, including constant touch point areas, were documented on a schedule.

The service supported contact with people’s friends and family through telecommunications and a visiting pod. Relatives we spoke with told us how the service had ensured their loved ones had contact and engagement from family and friends. Activities had been adapted to ensure people were stimulated.

Worcester Lodge is a residential care home. It provides accommodation and personal care for up to 39 older people, some of whom are living with dementia. At the time of the inspection there were 31 people living at the service.

Worcester Lodge is situated in Clevedon. There are two areas to the service. The main house and Garden Wing which focuses on care and support for people living with dementia. There are communal lounges and dining areas.

People’s experience of using this service:

Improvements had been made to the services environment to ensure it was safe, clean and better maintained. Radiators were now covered. A programme of works scheduled areas for redecoration and refurbishments. Areas had been completed and other were in progress or planned.

New equipment and furniture was in place. This provided items that were clean, fit for use and in good working order. The garden area had been made safe.

Systems to monitor and review the quality of the service had been revised and amended to ensure areas were identified and actions taken. The management structure had changed to ensure responsibility was clear and tasks completed.

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

Rating at last inspection and update:

Requires Improvement (June 2019). This service had been rated as requires improvement at the previous three inspections (January 2017, June 2018 and June 2019).

We carried out an unannounced comprehensive inspection of this service in February 2019. Breaches of legal requirements were found. We issued two warning notices to the provider in relation to safe care and treatment and good governance. The provider sent us an action plan of how they would meet the registration regulation, notification of other incidents.

Why we inspected:

We undertook this focused inspection to check they had met the warning notices, fulfilled their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

Follow up:

We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

People’s experience of using this service: People were supported by staff who were kind and caring. Staff and managers had good relationships with people and knew them well. Staff were well trained and supported in their role.

Systems to monitor and review the quality of the service were not fully effective. Some areas did not always get identified, risk assessed or reviewed that needed improvement or may pose a risk to people. Such as hot surfaces, the environment, incidents and reducing infection control risks.

Activities were provided which people enjoyed. Positive feedback was received about the food at the service. Visitors were welcomed. People and relatives were involved in the service through meetings and questionnaires to gain feedback.

Care plans were person centred, containing information about people’s past, family and interests. Individualised details showed people’s preferences and routines. People were supported to retain their independence.

Improvements had been made to some areas identified at the last inspection. For example, people’s consent to care was sought in line with legislation and guidance. The service had also developed end of life care plans that were personalised and detailed.

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

Rating at last inspection: Requires Improvement (June 2018). This service has been rated as requires improvement at the previous two inspections (January 2017 and June 2018).

Why we inspected: This was a planned inspection based on the previous rating.

Enforcement: We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will continue to monitor the service through the information we receive. We will inspect in line with our inspection programme or sooner if required.

Worcester Lodge 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.

The service is registered to provide care and support for up to 39 people, some of whom are living with dementia. Nursing care is not provided. At this inspection there were 35 people living at the home.

There was a registered manager 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.

At the last inspection the service was rated as Requires Improvement. At this inspection we found the service remained Requires Improvement.

Three breaches of legal requirements were found following the last comprehensive inspection. People were receiving care that wasn’t person centred, systems and audits did not identify shortfalls and people receiving unsafe care and treatment. The provider sent us an action plan confirming how they were going to address these shortfalls. At this inspection we found some improvements had been made. People were receiving care that was person centred and their medicines and care safely. However, improvements were still required to quality assurance systems. As they failed to identify shortfalls relating to lack of effective Mental Capacity assessments and best interest decisions as well as Deprivation of Liberty Safeguards (DoLS).

People could be at risk of cross infection, due to lack of liquid hand soap and paper towels at the point of care. The registered manager following the inspection confirmed they had actioned this shortfall.

Environmental and individual risks were not always identified through a risk assessment that identified the risk and what measures were in place to reduce those risks. Action was taken following the inspection.

People received their medicines when required and safely.

People’s care plans contained guidelines for staff to following relating to people’s individual needs but no details were recorded of what people’s individual pressure relieving equipment should be set to.

People were support by staff who had suitable checks prior to working with vulnerable people.

People felt safe and were supported by staff who were able to identify abuse. People felt staff were kind and caring and that the management in the home were approachable.

People were supported by staff who had received supervision and an annual appraisal and training to ensure they were competent in their role.

Staff demonstrated how they provided people with privacy and dignity. Staff prompted people’s independence encouraging them to undertake certain aspects of their care.

People felt able to complain.

Care plans had important information relating to people’s individual needs, although more information could be recorded about people’s individual end of life wishes.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the back of this report for the action we took.

During the inspection there were 30 people living at the home. The accommodation is arranged in one building with a lift between floors for the main house and the Garden Wing on one level. There were communal spaces including a conservatory, lounges and dining rooms. People had individual bedrooms and some had an en-suite bathroom. People living at the home had dementia so their ability to verbally communicate with us during the inspection was mixed.

Prior to this inspection the registered manager had resigned following a period of absence, so the deputy manager had been promoted to manager. A registered manager is a person who has been 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 time of this inspection the manager was completing their application to become the registered manager. During the inspection the manager was supported by a new deputy manager.

People told us they felt safe but there were risks to their safety in relation to falls, risk assessments and medicine administration.

People had a choice of meals, snacks and drinks, which they told us they enjoyed. The chef provided alternative options if people did not want the daily options to ensure their preferences were met. However, there were times when weight loss was not being reported so action could not be taken.

Staff were aware of their responsibility to protect people from avoidable harm or abuse and staff had received training in safeguarding. Staff knew what action to take if they were concerned about the safety or welfare of an individual. However, there were limited systems in place to ensure all incidents were investigated and measures were put in place to reduce the risks to people.

The recruitment process did not always follow the provider’s own policies and procedures, which meant people were cared for by staff whose prior conduct including from previous employment had not always been checked.

The manager and staff had some understanding about making decisions for people when the lacked capacity to do so themselves. However, processes had not always been documented to demonstrate the required legislation had been followed. Where people had been prevented from leaving the home, the correct processes has been followed.

The manager and provider had followed their legal obligations to notify CQC. The provider regularly met with the manager to provide additional support.

Staff were receiving regular supervisions and appraisals and they received appropriate training to care for people and meet their needs.

There were some completed audits but the systems were not identifying all shortfalls in the home. This meant there was a risk actions would not be taken to improve care for people when there were concerns.

The provider and manager thought all care plans were personalised and contained enough information to inform staff how to meet people’s needs. However, people were not always central to their care and care plans lacked detailed guidance for some people. This meant there was a risk staff would not provide appropriate care in line with their needs.

Staff supported people to see a range of health and social care professionals. Staff supported and respected people’s choices and they knew how important this was.

People and visitors thought staff were kind and caring. We observed positive interactions between people and the staff. The privacy and dignity of people was respected and people were encouraged to make choices throughout their day.

People knew how to complain and there were good systems in place to manage the complaints. The manager and provider demonstrated a good understanding of how to respond to complaints.

We made a recommendation that the service seek advice and guidance about implementing the Mental Capacity Act.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the time of the inspection there were 34 people living at Worcester Lodge. The person in charge on the day of the inspection told us that the majority of people had a diagnosis of dementia.

We spoke with six members of staff, the person in charge, relatives, a visiting health care professional and the provider.

People's health was monitored and they had access to community health resources as required.

People's needs were assessed and regularly reviewed to ensure they were receiving care that met their needs.

We saw that if someone needed to go to hospital information was sent with them to enable them to be supported appropriately.

We left comments cards at the home to enable people to tell us about the care at Worcester Lodge. We received 16 completed comments cards after the inspection all of which were overwhelmingly positive. For example 'The home provides excellent dementia care' and 'I cannot fault them in any way'.

We saw that care plans were detailed and provided information that allowed staff to care for people in a person centred way. We observed a meal time and saw that people enjoyed their food and that where necessary people were gently encouraged.

We found that there were systems in place to monitor the quality of service provided. This was achieved through a programme of audits and feedback from people using the service and relatives.

During our visit we found occasional lapses in recordings which meant that there was a risk that staff would not be aware of the most appropriate ways to support people and meet their needs.