Archived: Colton Lodges Care Home

Colton Lodges Nursing Home is a purpose built home comprising of four units Newsam, Whitkirk, Elmet and Garforth. It provides care for up to 138 people. At the time of inspection 126 people were living at Colton Lodges Nursing Home.

At the last inspection in March 2015 we found the provider had breached three regulations associated with the Health and Social Care Act 2008.The registered person did not make appropriate steps to ensure that, at all times, there were sufficient numbers of suitably qualified and skilled and experience staff to meet people’s health and welfare needs. There were not suitable arrangements in place to ensure staff were appropriately supported in relation to their responsibilities to enable them to deliver care safely and to an appropriate standard. The registered person did not take proper steps to ensure that each person was protected against the risks of receiving care or treatment that was inappropriate or unsafe.

The provider told us they would meet the regulations by the end of August 2015. The provider had completed an action plan and on this inspection, we found improvements had been made with regard to these breaches.

At the time of this inspection the home had a registered manager. 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.

Overall, people who used the service and visiting relatives said there were enough staff to meet people’s needs. However, we noted that people who used the service had to wait for periods of time for the support they needed such as assistance with meals.

People told us they felt safe and did not have any concerns about the care they received.

There were systems in place to record accidents and incidents.

The premises and equipment were well maintained to ensure people’s safety. The premises were clean in all four units and decorated to a good standard.

Medicines were administered to people by trained staff and people received their prescribed medication when they needed it. However two peoples medication had not been received for two weeks from the local pharmacy.

There were policies and procedures in place in relation to the Mental Capacity Act 2005. Staff were trained in the principles of the Mental Capacity Act (2005). However in one unit staff did not fully understand what they must do to comply with the requirements of the Mental Capacity Act.

People were supported by staff who treated them with kindness and respect. Overall, their choices and preferences were respected and they were supported to make their own decisions whenever they could do so. Staff could explain to us what privacy and dignity meant to them and the people they supported.

Most people told us they enjoyed the food and got the support they needed with meals. However, some improvements were needed to ensure people who were underweight and needed support at mealtimes had staff to support and encourage them.

Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service. Staff felt supported and had regular supervisions and appraisals.

There were good systems in place to ensure complaints and concerns were fully investigated. People had the opportunity to say what they thought about the service and the feedback gave the provider an opportunity for learning and improvement. People told us they would feel comfortable raising concerns or complaints. People provided positive feedback about the unit managers and registered manager.

We saw the provider had a system in place for the purpose of assessing and monitoring the quality of the service.

Colton Lodges comprises of four separate houses. Newsam- Dementia, nursing and residential. Whitkirk- general nursing. Elmet- general nursing and Garforth residential.

At our inspection we gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Is the service safe?

Most people told us they were treated with dignity and their rights were respected. People's comments included:

'I get up when I want nobody tells me I have to get up.'

'They come and talk to me about what I need; quite regularly I think.'

However, we saw on occasions that people were not asked for their consent before any care interventions. For example, we saw on Newsam House that people were not asked for their consent when putting aprons on people during meal times or when being assisted by staff with moving and handling.

Some people on Whikirk House said they did not feel their dignity was respected as they had to wait too long for staff assistance, especially when they wanted to go to the toilet. Staff working on this house said they did not always have enough staff to meet people's needs fully.

Safeguarding procedures were robust and staff understood how to safeguard the people they supported. However, as mentioned below, the practice of locking the rooms of people who used the service to protect them from the unwanted attention of others was not safe.

We found on Newsam unit people were not cared for in a clean, pleasant and hygienic environment. There were systems in place to manage infection control and prevention, however, these were not effective.

We looked at the recruitment of new staff. We saw recruitment practice was safe and all necessary pre-employment checks had been carried out. Staff confirmed their recruitment had been robust and all necessary checks had been completed before they started work.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We saw applications had been submitted where there was a risk people who used the service were deprived of their liberty. Policies and procedures were in place and under review to ensure people's rights were protected. However, our inspection visit highlighted the need for further DoLS to be applied for as we found two people on Newsam House had been locked in their rooms to protect them from the unwanted attention of others. This practice was not safe.

Overall, people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Is the service effective?

People who used the service or their relatives told us they were asked about their care and able to make decisions about this. One person told us, 'When I first got here they sat and talked to me about what I need and what I like, things like that.'

One relative said, 'I come every day so I'm involved by default, whether they like it or not.' However, some care records did not show how people who used the service or their relatives were involved in their on-going review.

Care records showed that people had regular contact with health and other professionals. Specialist dietary, mobility and equipment needs had been identified in care plans when required.

People were cared for by staff who were supported to deliver care to an appropriate standard. Training records showed most staff in the home had completed mandatory training and other appropriate training to meet people's care and support needs. This included dementia care.

Is the service caring?

We observed some very positive interaction between people who used the service and staff. However there were occasions where we saw people being ignored.

Most people told us they felt they were well cared for. People's comments included:

'It's like a five star hotel, the food is great.'

'I need help when I have a bath, which was odd at first. They are very nice to me when they're doing it though; they talk to me and take care of me.'

Overall, people's family members were complimentary of the staff and care and support their relative received. One said, 'My relative (person's name) has been here a long time, I am very happy with the care they receive. They have got a special chair for my relative so they can get out of bed for some of the day.'

Is the service responsive?

We spoke with people who lived in the home about activities. Most people said they had enough to do and enjoyed the activities on offer. However, a number of people on Whitkirk House said they would like to do more. We did not observe any meaningful activity for people on Newsam House.

We saw people who used the service were, in the main, responded to promptly when they asked for any support or assistance. However, we noted on Newsam house that people had long waits for their lunch time meal and did not always receive a timely response when they pressed their call bell. People who used the service on Whitkirk house also told us they had to wait too long at times for assistance to get to the toilet.

Records we looked at showed people knew how to make a complaint if they were unhappy. We looked at complaints records to see how they were dealt with. We found they had been investigated thoroughly and people were, in the main, responded to in a timely manner.

Is the service well led?

Staff said they felt the service was well managed and the management team were supportive. They said they were kept informed of any issues affecting the service.

Senior managers from the organisation carried out a monthly audit to check standards and the quality of care being provided. We saw there were action plans developed when any shortfalls were identified.

The provider had systems in place to identify and assess risks to the health, safety and welfare of people using the service. However, these were not fully embedded in all areas of the service and did not clearly show how the service was monitored to ensure improvements were made and standards were maintained.

The care records contained information about people's care needs and staff arranged the health care people needed. Most of the care practice we saw was safe and considerate. We saw that staff were respectful and kind when they spoke with people. During lunchtime staff did not speak with the people who used the service. We informed the manager during the inspection that we had observed this. They told us they would speak with the staff concerned.

The provider had systems in place to assess and monitor the standards at the home and action plans showed they address items that came to their attention. People expressed their views about the service. The staff listened to people and took account of their comments. We spoke with six people who used the service about their experience of living in the home. They told us 'Staff looked after them well' and 'A carer took them out to the local shops'.

People we spoke with said they enjoyed living at the home and were very satisfied with the care and support they received. Comments included: 'The staff are kind and lovely', 'I like living here' and 'It is really nice here.' Relatives we spoke with said they were involved in making decisions about their relative's care, their comments included: 'Staff are excellent' and 'Staff tell you what is happening and they involve us in the care.'

Some people who lived at Colton Lodges had a diagnosis of dementia; as such their ability to recall their experiences and express their views was limited. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. This allows us to spend time observing what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they had positive experiences.