All inspections: Helene Lodge - Care Quality Commission

This inspection took place on 21 and 22 July 2016 and was unannounced.

Helene Lodge is a care home without nursing for up to six adults with learning disabilities. There were five people living there when we inspected. It is a detached house in a residential area, with a paved garden at the back and a gravelled parking area in front. Accommodation is located on the ground and first floor, which is accessed by stairs. Each person has their own bedroom and some bedrooms have ensuite facilities. Shared facilities include two lounges, a conservatory, a kitchen/dining room and a toilet and bathroom on the first floor.

The service 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.

At our inspection in January 2015, we found breaches of the regulations relating to person centred care, safeguarding people from abuse and improper treatment, cleanliness and infection control, managing medicines, premises and equipment, record keeping, good governance, staff support and staffing levels. Some of these breaches were repeated and we issued two warning notices telling the provider to make improvements to staffing and to their assessment and monitoring of the quality of the service. We also asked the provider to make improvements to the other areas. The service was rated as inadequate in relation to the question ‘Is the well led?’, as requires improvement with regard to whether the service was safe, effective and responsive and as good in relation to whether the service was caring. At that inspection the service received a rating of requires improvement overall.

At our last inspection in July 2015 to check the provider had acted on the warning notices, we found they had made the required improvements to staffing and to monitoring and assessing the quality of the service.

At this inspection in July 2016, we found that action had been completed to meet the relevant legal requirements.

People benefited from a safe service where staff understood their safeguarding responsibilities. They were protected against the risk of abuse, including financial abuse. The premises were maintained in a clean, safe condition.

People were treated with respect and dignity by staff and their care and support needs were met. People had access to activities they enjoyed at home and in the wider community.

People were involved in decisions about their care and support, and their wishes and preferences were respected. Where people were unable to make decisions about particular aspects of their care, staff followed the principles of the Mental Capacity Act 2005, including the Deprivation of Liberty Safeguards. Risks to people’s personal safety had been assessed and plans were in place to minimise these risks.

People were supported to maintain their health and wellbeing. People told us they liked the food and they had a choice of meals. They were encouraged to eat healthily, whilst respecting their preferences, and their weight and body mass index were monitored for unplanned changes and any risk of malnutrition. Healthcare professionals were consulted when there was cause for concern about people’s health or health advice was needed, including dietary advice. Medicines were managed safely.

There were sufficient staff on duty. Staff morale was good and staff were supported through training and supervision to perform their roles effectively.

Quality assurance processes were in operation. People, relatives and staff were able to give their views about the service through periodic quality assurance surveys and informal meetings. These were used in developing the service, such as taking steps to make it look more homely. Regular checks and audits were undertaken, and any issues identified were put in order.

We carried out an unannounced comprehensive inspection of this service on 26 and 30 January 2015. Breaches of legal requirements were found and we issued warning notices for repeated breaches in staffing and in good governance (assessing and monitoring the quality of service provision). The provider was required to meet the regulations relating to staffing and to good governance by 29 May 2015. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the other breaches in the regulations. These breaches related to: person-centred care, safeguarding people from abuse and improper treatment, safe care and treatment including infection control and the management of medicines, premises and equipment, records and supporting staff.

We undertook an unannounced focused inspection on 8 July 2015 to check they had taken action to meet the regulations relating to staffing and in good governance and to confirm that they now met legal requirements. We also checked that they had followed their action plan in relation to premises and equipment. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Helene Lodge on our website at www.cqc.org.uk.

You can read a summary of our findings from both inspections below.

Helene Lodge is a care home without nursing for up to six adults with learning disabilities. There were five people living there when we inspected, on both occasions. It is a detached house in a residential area, with a paved garden at the back and a gravelled parking area in front. The building is not wheelchair-accessible, although people living there are able to walk around independently. Accommodation is located on the ground and first floor, which is accessed by stairs. Each person has their own bedroom and some bedrooms have ensuite facilities. Shared facilities include two lounges, a conservatory, a kitchen/dining room and a toilet and bathroom on the first floor.

Comprehensive inspection on 26 and 30 January 2015

At our previous inspection in April 2014, we asked the provider to take action to make improvements to staffing and to their assessment and monitoring of the quality of the service. They sent us an action plan that stated they would meet the relevant legal requirements for staffing by 29 July 2014 and for assessing and monitoring the quality of the service by November 2014, after the new fire alarm system had been installed.

At the inspection in January 2015, people told us they liked Helene Lodge and its staff, whilst relatives expressed mixed views. Staff treated people in a caring manner, respecting their privacy and dignity, but our findings did not all match the positive views we heard. There were a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

People’s assessed needs were not fully met because there were not enough staff on duty. There was no system to adapt staffing levels to people’s changing needs. Because of this, people had limited social opportunities outside of day centres, in the evenings and at weekends. Staff were not always able to fulfil all the duties expected of them as well as meeting people’s support needs. This was a repeated breach of the Regulations.

Additionally, there were continuing shortfalls in the provider’s quality assurance and risk management systems. Action had not been taken to address risks to people’s health, safety and welfare. Repairs remained outstanding and water from some taps was dangerously hot despite having been reported by staff. There was no system for people, relatives and staff to give their views about the service and have these addressed. Information from quality assurance surveys, incidents, comments and complaints was not used to improve service quality. Audits of the service were not robust and actions arising were not followed up. This was a repeated breach of the Regulations.

Whilst there were minor scuffs to paintwork on walls and doors, and worn settee covers in one of the lounges, the décor was reasonably intact. However, some aspects of the premises required attention, including broken electrical fittings and the heating in one person’s room.

Staff received basic training, but did not have regular, documented supportive meetings to discuss their work with a manager.

Care plans were not kept under review and were not all sufficiently detailed for staff to be sure about the support people needed. They did not fully reflect advice or instructions from health and social care professionals about how to support people safely. People’s risk assessments had not been reviewed and updated regularly or in response to accidents or incidents. This meant staff might not have been aware of particular threats to the person’s safety and wellbeing and how best to manage these.

Staff were aware of how to report concerns that someone could be experiencing abuse. However, reasonable steps had not been taken to identify or prevent the possibility of financial abuse.

Medicines were not stored securely, and handwritten medicines administration records (MAR) were not checked to ensure they contained the correct instructions.

Focused inspection on 8 July 2015

After our inspection of 26 and 30 January 2015 we served warning notices on the provider in relation to staffing and to good governance (assessing and monitoring the quality of service provision). These required the service to meet these regulations by 29 May 2015. We undertook this unannounced focused inspection to check that these breaches of the regulations had been addressed. We also checked whether the provider had followed their action plan in relation to the breaches in relation to the premises and equipment.

There were five people living at the home at the time of our 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.

The provider had made improvements to meet the regulations relating to staffing and to good governance (assessing and monitoring the quality of service provision).

There had been improvements to staffing levels, which were sufficient to keep people safe and meet their support needs. Additional staff were on duty at busy times when people were at home: first thing in the morning, late afternoons and early evenings and at weekends. This allowed people to go out more than they had done when we last inspected. However, shift patterns and the use of agency staff meant that it was sometimes difficult to support people to attend evening social activities. The registered manager told us they would review shift patterns when more permanent staff were in post.

There were improved systems for assessing and monitoring the quality of the service. A quality and improvement manager had been recruited to oversee and address the quality of all three of the provider’s homes. The provider had taken action in response to issues raised in our last inspection report. There was a programme of quality audits and health and safety checks. Feedback from people and relatives was used to develop the service. Results from a recent quality assurance survey of relatives and staff had been used to develop and improve the service.

Maintenance and furnishing issues highlighted in our last report had been addressed. Substantial steps had been taken to address shortfalls in the maintenance and cleanliness of the premises and furniture. The premises looked clean, the back garden had been cleared and broken and unsafe items, such as bathroom lights, had been replaced. A maintenance person visited regularly and repairs were attended to promptly rather than being left for months.

One person’s radiator had not been working at the last inspection. The necessary central heating repairs had not yet been undertaken, as this would have entailed re-laying pipework. The registered manager said there were plans to replace the heating in that person’s room with an independent radiator. We will check this at our next inspection.

Hot water taps had regulators fitted so that hot water came out at a safe temperature. Staff checked hot water temperatures daily. These were mostly within safe limits and on those occasions the limits were exceeded, tap regulators had been adjusted to bring the temperature down.

The ripped flooring in the shared bathroom had not yet been replaced. The management team advised there were plans to refurbish this room as a priority above other rooms, at which point the flooring would be replaced. We will review this at our next inspection.

Helene Lodge is a care home without nursing for up to six adults with learning disabilities. There were five people living there when we inspected. It is a detached house in a residential area, with a paved garden at the back and a gravelled parking area in front. The building is not wheelchair-accessible, although people living there are able to walk around independently. Accommodation is located on the ground and first floor, which is accessed by stairs. Each person has their own bedroom and some bedrooms have ensuite facilities. Shared facilities include two lounges, a conservatory, a kitchen/dining room and a toilet and bathroom on the first floor.

The previous registered manager stepped down in July 2014 and has since left. A new home manager has started in post but has not yet applied to register. The service is required to have a registered manager as a condition of its registration. 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 our last inspection in April 2014, we asked the provider to take action to make improvements to staffing and to their assessment and monitoring of the quality of the service. They sent us an action plan that stated they would meet the relevant legal requirements for staffing by 29 July 2014 and for assessing and monitoring the quality of the service by November 2014, after the new fire alarm system had been installed.

At this inspection, people told us they liked Helene Lodge and its staff, whilst relatives expressed mixed views. Staff treated people in a caring manner, respecting their privacy and dignity, but our findings did not all match the positive views we heard. There were a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People’s assessed needs were not fully met because there were not enough staff on duty. There was no system to adapt staffing levels to people’s changing needs. Because of this, people had limited social opportunities outside of day centres, in the evenings and at weekends. Staff were not always able to fulfil all the duties expected of them as well as meeting people’s support needs. This was a repeated breach of the Regulations.

Additionally, there were continuing shortfalls in the provider’s quality assurance and risk management systems. Action had not been taken to address risks to people’s health, safety and welfare. Repairs remained outstanding and water from some taps was dangerously hot despite having been reported by staff. There was no system for people, relatives and staff to give their views about the service and have these addressed. Information from quality assurance surveys, incidents, comments and complaints was not used to improve service quality. Audits of the service were not robust and actions arising were not followed up. This was a repeated breach of the Regulations.

Whilst there were minor scuffs to paintwork on walls and doors, and worn settee covers in one of the lounges, the décor was reasonably intact. However, some aspects of the premises required attention, including broken electrical fittings and the heating in one person’s room.

Staff received basic training, but did not have regular, documented supportive meetings to discuss their work with a manager.

Care plans were not kept under review and were not all sufficiently detailed for staff to be sure about the support people needed. They did not fully reflect advice or instructions from health and social care professionals about how to support people safely. People’s risk assessments had not been reviewed and updated regularly or in response to accidents or incidents. This meant staff might not have been aware of particular threats to the person’s safety and wellbeing and how best to manage these.

Staff were aware of how to report concerns that someone could be experiencing abuse. However, reasonable steps had not been taken to identify or prevent the possibility of financial abuse.

Medicines were not stored securely, and handwritten medicines administration records (MAR) were not checked to ensure they contained the correct instructions.

Most areas of the house were visibly clean, but one bathroom was dirty, with faecal staining on the toilet. Soap and towels were not available in the upstairs shared bathroom for people to wash their hands after using the toilet. The infection control policy did not address the matters required by the Health and Social Care Act 2008 Code of Practice on the prevention and control of infections.

Some records were inaccurate and incomplete, which meant that staff and managers did not have all the information they needed in order to provide the care people needed or for the management of the service.

Additionally, we identified areas where improvements could be made. These related to person-centred care planning, screening for malnutrition and documenting consent to medicines.

Summary

We carried out this inspection after receiving information of concern that people were sometimes inappropriately dressed and might not be receiving sufficient support. We had already been due to inspect the home shortly, as a new provider had acquired Helene Lodge in August 2013. At the time of our inspection, there were five people living at the home, all of whom had lived there for several years.

We considered our inspection findings to answer questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

This is a summary of what we found.

Is the service safe?

There were not enough qualified, skilled and experienced staff to meet people's needs. Arrangements to cover staff absences were not robust and meant that staff might not have sufficient time to rest. The staff rota restricted the time the registered manager had to attend to their management duties, as when they were on duty they were included in the staffing numbers to provide care and support for people who lived at the home.

Sufficient steps had not been taken to ensure that people on duty were suitably skilled in order to safeguard people's health, safety and welfare. Staff prepared and handled people's food but had not all received food hygiene training. Additionally, a support worker who assisted people with their medicines had not undertaken medicines training or a competency assessment since they had worked at the home. The registered manager had not undertaken training in the role of managers in safeguarding vulnerable adults.

People were not adequately protected against the risk of fire. We spoke with Dorset Fire and Rescue Service about fire precautions at the home. They visited and have informed us that they require improvements to the fire precautions.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People living at the home felt safe with the staff who supported them. Throughout our inspection visits, we observed that people freely approached staff and looked relaxed in the company of staff. Staff were aware of the importance of behaving in a professional way towards people. There were arrangements in place to safeguard people against the risk of financial abuse.

By the end of our inspection, all staff had completed awareness training in safeguarding vulnerable adults. However, we were unable to check that all support workers had an adequate understanding of their role in safeguarding the people they support.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DOLS). During the inspection the registered manager took action to ensure that the home was meeting legal requirements relating to DOLS. No one living at the home was currently subject to DOLS, but four of the five people were unable to leave the home unsupervised. The registered manager contacted the local authority DOLS team during our first visit. They informed us at the second visit that they were awaiting advice from the team and would submit applications accordingly.

Is the service effective?

People were supported in promoting their independence and community involvement. We observed that staff promoted people's independence and involvement in their care.

People had access to activities outside the home and their care records reflected this. They had regular contact with people who were important to them, such as members of their families.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were supported to manage long term conditions such as epilepsy.

Is the service caring?

People's privacy, dignity and independence were respected. We saw that people were clean, well-kempt, wore suitable clothing and that staff treated them with consideration and respect. We observed that staff checked what people wanted to do and respected their preferences and wishes. Staff remained calm and respectful in all the interactions we saw or heard with people living at the home. People told us that the staff were kind to them. For example, one individual described a support worker as 'a very nice lady'.

Is the service responsive?

People expressed their views and were involved in making decisions about their care and treatment. Their support plans were individualised and reflected advice from health and social care professionals. Care and treatment was planned and delivered in line with people's individual support plans. Support plans for the people we pathway-tracked were clear and straightforward for staff to follow. The staff we spoke with were familiar with individuals' support plans and were able to tell us about the care they needed. We observed that staff followed people's support plans. This helped ensure that people had their needs met.

People had contact with healthcare professionals to ensure their health needs were met. For example, records showed that both individuals had seen their GP when they felt unwell and that they also saw health professionals for routine health screening, such as annual health checks and dental check-ups.

Is the service well-led?

The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.

Appropriate actions had not been taken in response to monthly management audits. For example, there was no legionella risk assessment or management plan in place; legionella are water-borne bacteria that can cause serious illness. This had been highlighted on several months' audits.

People's representatives were not always asked for their views about people's care and treatment. Staff at the home had not informed an individual's representatives about the person's injury from a fall in 2014. This meant the person's representatives did not have an opportunity to comment on or ask questions about the incident. It also limited the opportunities for learning from the incident.

Archived: Helene Lodge

All Inspections

21 July 2016

During a routine inspection

8 July 2015

During an inspection looking at part of the service

26 and 30 January 2015

During a routine inspection

22, 27 April 2014

During an inspection in response to concerns