Liberham Lodge

We found the following examples of good practice.

• Enhanced visiting processes in place and being reviewed to keep in line with Government guidance. This ensured that people who had been identified as struggling through the pandemic or showing any distressed behaviour had been able to have access to visitors. Each visit through the pandemic was risk assessed on an individual basis to ensure people and relatives were kept safe.

• There was a high level of communication with people and relatives through the pandemic. The registered manager had provided updates on a regular basis to relatives around any outbreaks and provided updates on people’s health and wellbeing to relatives. The registered manager was able to obtain additional feedback and ideas from people’s relatives on ways to encourage people through the pandemic to keep it as person-centred as possible.

• The provider set up a Covid-19 taskforce which provided support to all the services in the organisation. The taskforce concentrated on ensuring all Government guidance was passed through to services. The taskforce also reviewed how each service had been responding and provided support and guidance around all areas such as human resources, management, dining and policy changes.

• The registered manager involved staff with the daily management around Covid-19. A staff member had taken on the responsibility of Covid-19 coordinator within the home. This staff member was responsible for monitoring daily tasks such as Covid-19 testing with people and relatives. This ensured any identified actions were identified in a timely manner and brought to the attention of the registered manager to be actioned.

• During any outbreaks of Covid-19 in the home it had been possible to split the home into zones to minimize the spread of infection. If needed these zones could also be split further to ensure there was no mix of residents who had tested positive and those who had tested negative.

• Any potential admission into the home were part of a robust management process to ensure all details had been obtained to be able to complete an individual risk assessment prior to attending the home. Any new admissions into the home were also subject to a 14-day isolation period and regular testing as per Government guidance.

• The registered manager had ensured there was plenty of personal protective equipment (PPE) available to staff. Staff had been observed safely using PPE within the home. PPE stations had been set up outside of rooms and discreet, yet clear signage was on display to remind staff of the people who were isolating within their rooms.

Gracewell of Bookham is a ‘care home’ providing personal and nursing care for up to 70 people. The service is provided in one adapted building which is divided into three wings, each with their own lounge and dining area. At the time of our inspection 58 people were living at the service.

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

People said they were cared for by staff who were kind and caring. People told us here was enough going on at the service to keep them busy and they enjoyed the entertainment.

People were helped to stay safe as staff understood their responsibility to report any concerns and staff followed guidance in place in relation to people’s individual risks. Medicines were managed safely. Lessons were learned when things went wrong.

People and their relatives told us they were treated well. Staff understood equality and diversity. People

could express their views and be involved with choices around their care and treatment. People told us their

privacy and dignity were respected and their independence promoted.

People’s care plans were detailed, and staff used these to understand the care people required.

People lived in an environment that was maintained and cleaned to a good standard. People told us they could remain independent and the environment had some signage and communication aids for people living with dementia. People had access to healthcare professional involvement if they needed it and they received the medicines, food and hydration they required.

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 were given privacy when they wished it, but also enabled to move around freely and independently in a safe way.

People were cared for by a sufficient number of staff and staff told us they felt they were trained and supported in a way that enabled them to carry out their role competently.

People told us they thought highly of the management team. The manager was responsive and

wanted to improve the service to the benefit of people who lived there. People held meetings and were

engaged with the service.

Quality assurance checks were carried out to help ensure people lived in a service that was safe. Actions identified from these checks were addressed. People were asked for their feedback and this was used to help improve the service. Staff worked with other agencies to help improve the service people received.

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 requires improvement (published 23 October 2018).

At this inspection we found sufficient improvement had been made and the provider was no longer in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

There was a manager in place who had applied to become the registered manager with the CQC. 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. On the day of the inspection the manager was on leave, however the deputy manager was available and spoke with us.

At this inspection, we observed that medicines were not always managed safely. Infection control checks were carried out but were not robust. There were system’s in place for monitoring and investigating accidents and incidents, however, learning from these were not disseminated to staff. Food and fluid charts were not always completed in full. The provider did not have an accessible information (AIS) policy in place so that people were provided with information about the service in a format that they could easily understand. Staff understood the Mental Capacity Act (2005), however, best interest meetings had not always been documented. Care plans were not always available in people’s care files for staff to consult should the need arise. People were supported to have a balanced diet; however, food and fluid charts were not completed in full and monitored. Care plans did not always record people’s diverse needs. There were not effective systems in place to monitor the quality and safety of the home as the provider had failed to identify the issues we found at this inspection. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe and there were appropriate safeguarding procedures in place to protect people from the risk of abuse. There were enough staff deployed to meet people’s needs and the provider followed safe recruitment practices.

Staff received an induction when they started work and were supported through a programme of regular training and supervisions to enable them to effectively carry out their roles. People's needs were assessed prior to moving into the home to ensure their needs could be met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff told us they asked for people’s consent before offering support. People’s care files included assessments relating to their dietary support needs and they were supported to have enough to eat and drink. People had access to healthcare professionals when required to maintain good health and the service worked with them to ensure people received the support they needed. The service met people's needs by suitable adaptation and design of the premises, which included appropriate signage to help people orientate themselves and appropriately adapted bathrooms to manage people’s needs effectively.

People told us staff were caring and respected their privacy and dignity and that they had been consulted about their daily care and support needs. People were supported to be independent wherever possible. People were provided with information about the service when they joined in the form of a 'service user guide' so they were aware of the services and facilities on offer.

People’s care plans were reflective of their individual care needs. There were a variety of activities were on offer for people to enjoy and take part in. People were aware of the home’s complaints procedures and knew how to raise a complaint. People's religious beliefs were recorded and they were supported to meet their individual needs if required. Where appropriate people had their end of life care wishes recorded in care plans.

Regular staff and residents' meetings were held where feedback was sought from people. Staff were complimentary about the manager and the home. The provider worked in partnership with the local authority and other external agencies to ensure people’s needs were planned and met. The manager was knowledgeable about the requirements of a registered manager and their responsibilities about the Health and Social Care Act 2014. Notifications were submitted to the CQC as required. The ethos of the home was to provide high quality, personalised nursing, residential and dementia care.