Lostock Lodge Care Home

We found the following examples of good practice.

Staff were provided with the personal protective equipment (PPE) they needed. We observed this was used in accordance current with national guidance.

People living at Lostock Lodge were able to see family members through window visits. Indoor visits had been in place but paused with the recent increase in local infection rates. The registered manager was ensuring that people at ' end of life' were still able to see their family.

The provider ensured friends and family were kept informed of infection outbreaks and changes to visiting arrangements through regular

daily phone calls, email updates and newsletters.

The guidance around 'isolation' was being followed for people who had been newly admitted to the home, those returning from hospital or those awaiting hospital inpatient treatment. Staff were carrying out activities on and one to one basis to keep people occupied whilst staying in their bedrooms.

Cleaning schedules and routines had been increased and to reduce the risks of cross infection.

Further information is in the detailed findings below.

Lostock Lodge Care Home is a residential care home providing personal and nursing care to 57 people at the time of the inspection. The service is registered to support up to 66 people.

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

Improvements to the management of medicines and governance of the service found at the last inspection had been sustained.

People told us they felt safe and received their medicines on time. One person told us, “They are so diligent in making sure that I take my medicines at the right times." There were systems in place to safeguard people from abuse and risks to people’s health and safety had been assessed. There were enough numbers of appropriately trained staff on duty to meet people’s needs and people did not have to wait when they needed assistance. One person said, “They really look after us here and if I want a bath or a shower they try to help straightaway.”

People enjoyed the homemade meals, drinks and snacks available throughout the day. People’s needs, and preferences had been assessed and planned for. One person told us "The chef is very good here and knows exactly what I need in my special diet.” Staff supported people to access support from healthcare services when needed and ensured any advice they provided was followed. The environment had been fully adapted to meet people’s needs, there was level access throughout and people had a choice of where they spent their time.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and their relatives gave us positive feedback about the quality of care and staff approach. One person commented, “One thing is certain, they are excellent at providing care. ”We observed many caring and people were treated with dignity and respect. A relative commented, “It is noticeable here that no one is forgotten about, all credit to the staff."

People’s needs, and preferences were kept under review. Staff had access to the information they needed to support people safely and effectively. People enjoyed the wide range of activities and trips on offer and staff spent time talking with people as much as possible. People were able to give their views on their care and felt listened to.

There were effective systems in place to monitor the safety and quality of service being provided. People, their relatives and staff had the opportunity to give their views on the service through quality assurance surveys. The results of which were used to bring about improvements. people and their relatives felt the service was managed well. one person told us "Without question this home is well led, just like a 5* hotel.".

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 good (published 5 April 2018).

Why we inspected

This was a planned inspection based on our previous rating.

Lostock Lodge is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Lostock Lodge is a purpose-built home offering accommodation and support for up to 66 people. At the time of our visit there were 42 people living at the home.

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. The service had appointed a new manager following the resignation of the registered manager and they took up this post in April 2018.

During the last inspection on 28 February 2018 and 5 March 2018 we found that there were a number of improvements needed in relation to safe care and treatment, dignity and respect, staffing, training and competence, accidents and incidents, and good governance. These were breaches of Regulation 10, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was placed in special measures.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Caring, Responsive and Well Led to at least good. The provider sent us an action plan that specified how they would meet the requirements of the identified breaches.

During this inspection we found all the required improvements had been made. The service has been removed from special measures.

Improvements had been made to the management and administration of medicines. We found that medicines were managed safely in accordance with good practice guidelines. Staff had received training and had their competency assessed.

Improvements had been made to the recording of accidents and incidents. Documents were consistently and fully completed and reviewed by the registered manager. Analysis took place to identify trends and patterns.

We found improvements had been made to the management and mitigation of risk. Records clearly identified areas of risk specific to the person and gave clear guidance that included the level of intervention required for staff to follow to mitigate the risk to people.

Improvements had been made to the deployment of staff across the home. Sufficient staff were employed to meet the needs of the people supported. Staff were evenly deployed across the home to meet people’s individual needs.

Improvements had been made to the consistent completion of induction of staff at the home. Staff employed since our last inspection had all undertaken an induction at the start of their employment. This included organisational induction and the completion of the Care certificate.

People told us that staff consistently treated them with respect and their dignity was respected.

The registered provider had improved the effectiveness of the quality assurance systems in place. Audits across many areas of the home were consistently completed. Action plans identified areas for development and improvement. The registered provider held bimonthly clinical governance meetings to overview the findings of all audits undertaken.

Safeguarding policies and procedures were n place. Staff had all received training and were able to describe what abuse may look like and actions they would take if they had any concerns.

People had their needs assessed before moving in to the home. This information was used to create person centred care plans and risk assessments. People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process.

Staff had developed positive relationships with people and demonstrated a good understanding of their individual needs. We observed positive interactions between staff and people that included comfortable conversations and banter.

People's food and drinks needs were met and clear guidance was in place for staff to follow to meet people's specific dietary needs.

People had the opportunity to engage in activities of their choice. People spoke positively about the activities available.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and report on what we find. We saw that the registered provider had guidance available for staff in relation to the MCA. Staff had undertaken training and demonstrated a basic understanding of this. Care records reviewed included mental capacity assessments and best interest meetings.

The registered provider had a complaints procedure in place and people told us they felt confident to raise any concerns or complaints.

Policies and procedures were available for staff to offer guidance within their role and employment. These were regularly reviewed and updated.

We previously inspected Lostock Lodge on the June 2017 and the service was rated Requires Improvement overall. We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulations 12, 17 and 18. This meant the registered provider had failed to ensure people were fully protected from the risk of unsafe care, staff did not have sufficient training and there was ineffective oversight of the service. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to breaches.

At this inspection we identified multiple new or repeated breaches of the regulations relation to assessing and mitigating risks to people’s health and wellbeing, the safe management of medicines, dignity and respect and good governance.

We will update the section at the end of this report to reflect any enforcement action taken once it has concluded.

Lostock Lodge 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 care home accommodates 66 people in a purpose built building. There are three separate units, each of which has separate facilities. One of the units specialises in providing care to people living with dementia. At the time of the inspection 56 people were living at the service,

There was no 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. The service had appointed a new manager following the resignation of the registered manager and they took up this post in January 2018.

People could not be assured that risks to their safety were always assessed or kept under review. Risks were not always reduced as much as possible. There were a number of incidents between people who used the service but no action had been taken to explore ways of monitoring or managing behaviours that challenged. Therefore, the registered provider was not taking reasonable steps to keep people safe.

We found that people were at risk because their medications were not being recorded, administered and stored in accordance with guidance. Staff were not competent to administer people’s medicines safely and effectively. Staff were not adhering to the registered providers polices the management of medication and any training staff had received had proven to be inadequate.

People were supported by staff whom were caring; however people could not always be assured that sufficient care was taken to maintain their privacy and dignity. We found that there was an insufficient number of suitably trained and competent staff on duty to meet the needs of the people who lived at the service.

Care plans were detailed and person centred. However, these were not always updated with any changes. The registered provider and manager had not ensured that the care and treatment of people who lived at the home followed their care plan requirements to meet their needs.

The quality of food was good and people enjoyed it. However, the registered provider and manager were not effectively monitoring the dietary intake of people who were deemed at risk of malnutrition. People were supported to eat but improvements were required to ensure that people were eating and drinking sufficient amounts.

Staff received training and supervision to provide them with the knowledge required from their role. However, there were insufficient checks undertaken to ensure that staff were competent and confident to put this into practice.

Quality assurance systems were in place but these had failed to identify risks presented to the people who lived at the home. They also did not address the concerns raised on this inspection. There was evidence of a failure to notify the CQC of notifiable incidences and failure to analyse incidents and learn from experience when things had gone wrong.

People knew how to raise concerns but these had not always been reported due to a lack of confidence that changes would occur. When they had been recorded, there was a record of what action had been taken.

Staff had an understanding of the Mental Capacity Act and followed its principles. There was a record of a person’s capacity to make a specific decision and where staff or others had made a decision in a person’s best interest.

Recruitment and selection of staff was carried out safely which meant vulnerable people protected from receiving care from unsuitable people.

The overall rating for this service is ‘Inadequate and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This was the first inspection of the service since it was registered with the Care Quality Commission on the 17 January 2017.

Lostock Lodge comprises a 66-bed care facility over three floors. It offers accommodation and personal care to adults with a physical disability or those living with dementia. Additionally, it offers respite care for individuals who need a short break away from their home, are uncertain about moving into a care home permanently, or require support following hospital treatment. At the time of the inspection there were 20 people using the service.

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.

We found that there were Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 that related to Staffing and Good Governance.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

At the start of their employment staff underwent a period of induction and this included the shadowing of other staff. We found that some staff had not been provided with training in key aspects of their role such as moving and handling, first aid, safeguarding, fire safety and infection control. This meant that there was a risk that staff did not have the appropriate knowledge and skills to provide support in a safe and effective way.

People received care and support from staff that had been through recruitment procedures to ensure that they were of suitable character to work in this setting. However, we found that there were occasions where staff had started prior to all the checks being made.

People told us that the building was clean, warm and comfortable. We found that improvements were needed to ensure that the building was ‘dementia friendly’. We made a recommendation that the registered provider take due consideration of best practice guidance in regards to this.

The registered manager and registered provider ensured that audits were carried out on a regular basis in order to monitor the quality, safety and effectiveness of the service. Where issues had been identified action was taken to minimise further occurrences or to make improvements to the service. However, we found that the audits were not robust enough to pick up all of the issues found on inspection. When these matters were raised with the registered manager she responding quickly and positively to ensure changes were made.

Care plans and risk assessments were in place to help staff deliver support in line with a person's wishes, preferences and personal history. Not all staff had read these to help them develop awareness and understanding of a person’s needs. Staff had relied on handover to discuss a person’s needs and any changes to the support required. This meant that the correct support may not be delivered. The registered manager was taking steps to remedy this.

Updates were made to care plans and risk assessments where there was a change in a person’s support requirements. We spoke to the registered manager about the need to complete a new care plan where there were significant changes in order to clearly direct staff in managing certain aspects of a person's care.

People and their relatives made positive comments about the care received and were complimentary about the food. Observations indicated that people were happy at the service and there were warm and friendly interactions with staff. People had the opportunity to take part in a number of activities of their liking.

Where people were not able to indicate what they wanted, staff knew them well enough to anticipate their needs. The requirements of the Mental Capacity Act 2005 were met and staff helped people to express themselves and to seek consent. People told us that they were given choices, allowed to take risks and staff included them in decision making. Applications had been made under the Deprivation of Liberty Safeguards where it was felt a person's liberty was being restricted or deprived.

Staff were aware of what was meant by safeguarding adults and aware of what things they needed to report. They said they were confident to report matters of concern.

People were aware of how to make a complaint. They said that the staff and the registered manager were always available and would have no hesitation in going to them with worries and concerns. The registered manager responded in a timely manner to any complaints or concerns and was open and transparent where issues had arisen.