About the serviceSmyth Lodge is a care home and respite service set over three floors and provides residential care and support, nursing care and dementia care for up to 80 older people. At the time of our inspection, 43 people were using the service.
People's experience of using this service
Medicines were not safely managed. Medicines were not always administered in a timely manner or in line with the prescriber’s directions. Medicine competency checks were not always carried out to ensure staff remained competent to administer medicines safely. There were not enough staff available to meet people’s needs in a timely manner. Risks to people were not always assessed or reviewed and the provider did not always have appropriate risk management plans in place to guide staff on how risks should be minimised. Accidents and incidents were not appropriately managed and learning from them was not disseminated to staff.
Where people were at risk of dehydration, fluid charts were not always completed and prompt referrals were not made to health professionals for additional support. Staff were not supported through regular supervisions. There was no appropriate signage within the home to help people orientate themselves.
Care plans and risk assessments were not always updated when there was a change in people’s needs and there was not always updated guidance in place for staff to follow. Staff meetings were held but not all staff attended these on a regular basis. The provider's quality monitoring systems were not effective. Internal audits did not identify the issues we found at this inspection.
People said they felt safe and that their needs were met. People were protected against the risk of infection. Assessments of people’s needs were carried out prior to them moving to the home to ensure their needs could be met. Staff training was up to date. Information was available to people in a format to meet their individual communication needs when required. The service was not currently supporting people who had end of life care needs, but relevant information was recorded in their care plans so this was available when people required this support. Complaints were documented and investigated in a timely manner.
People's rights were upheld with the effective use of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. Their needs were not accurately assessed, understood and communicated.
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
This service was registered with us on 4 February 2019 and this is the first inspection.
Enforcement
We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person-centred care, dignity and respect, safe care and treatment, premises, staffing and good governance.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up:
We will ask the provider to complete an action plan to show what they will do and by when to improve. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner. We will also meet with the provider.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.