Archived: Park Lodge

Updated 2 June 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This unannounced inspection took place on 18 and 20 August 2015. This inspection was carried out to follow on from our inspection on 19 January 2015 when we rated the service ‘Inadequate’ and to check that improvements the provider told us they would make in relation to the breaches of regulations had been met.

This inspection was carried out by one inspector and a specialist advisor who was a Registered General Nurse.

Before our inspection we reviewed all information we held about the service and the provider including looking at the previous inspection reports and reviewing these in line with the action plan the provider submitted to the Care Quality Commission (CQC).

During this inspection, we spoke with six people living at the home, two relatives, two nurses, five care staff, the manager and area manager. We also spoke with the nurse from the local nursing impact team.

We looked at the care records for four people and more closely at the care and support three of the four people received. We reviewed the medicines records for all the people who lived at Park Lodge. We also looked at other records that related to how the home was managed including the quality assurance audits that the manager and provider, CHD Living Ltd, completed. We also looked at three staff files and five staff supervision records and the training records for all staff employed at the home.

We observed care and support in communal areas. To do this we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Updated 2 June 2016

We carried out this unannounced comprehensive inspection on 18 and 20 August 2015. At our last inspection on 19 January 2015 we found eight breaches of regulations and rated the service as ‘Inadequate’. At the time, we judged one breach was serious enough, that we served a warning notice on the provider and told them to make the necessary improvements by 17 April 2015. This was because the provider was failing to protect people who used the service and others against the risks of inappropriate or unsafe care. They did not have effective systems to identify, assess and manage risks relating to their health, welfare and safety. We undertook a focused inspection on the 21 May 2015 to check that the provider had met the regulations and found the necessary improvements had been made.

The other breaches of regulations, we found at the inspection on the 19 January 2015, were in relation to the unsafe use and management of medicines, a lack of staff support and training, people’s nutritional and hydration needs were not being met, care plans for the support people required were not detailed enough to describe how to meet people’s individual needs, the provider did not send the Care Quality Commission (CQC) notifications in a timely manner and the provider had not taken the correct actions to ensure that the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. The provider sent us an action plan and told us they would make the necessary improvements by the end of May 2015.

Park Lodge provides accommodation and nursing care for up to 35 older people, some of whom may have dementia. There were 15 people living at the home when we visited.

The home did not have a registered manager. The previous interim manager at Park Lodge had left and a new manager was recruited in late May 2015, they had applied to the CQC to be the registered manager at this location. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 this inspection we found the provider did not have suitable arrangements to protect people against the risks associated with medicines. We found that not all medicines were stored safely.

We observed part of the morning medicine administration round on both days and found the nurse was constantly disrupted and the medicines round took more than two and a half hours on each day. The length of time taken to administer medicines meant that there were risks that people might not receive their medicines at a time or at the intervals prescribed by their doctor.

We looked at the medicines administration records (MAR) for each person using the service. These showed several omissions in the recording of the application of creams or ointments, with no explanations given. This meant that medicines records were not adequate to show people were receiving their medicines as prescribed for them.

The provider did not have effective systems to assess, review and manage risks to ensure the safety of people and others. For example we saw the boiler room and the sluice room on the first floor were unlocked throughout the day and could be easily accessed by people walking by. In the kitchen we found numerous items of out of date food, which had not been noted by staff. We saw that a mop and bucket containing dirty water was stored in a cupboard containing dry food goods, such as flour and sugar increasing the risks of the spread of infection. The provider did not ensure that the premises were cleaned to an adequate standard. Where risks were identified these had not been followed up with an action plan so these could be minimised.

Training records showed that the majority of staff had received recent training in safeguarding adults at risk and staff were aware of what constituted abuse and the action they should take to report it. We observed that there were sufficient numbers of staff on duty to care for and support people to meet their needs, but at times staff were very busy and did not always have the time to engage and interact with people.

We saw that although people were supported to eat and drink throughout the day, people’s nutritional needs were not regularly monitored and assessed so the risk of malnutrition could be identified early for action to be taken to minimise this. There was no permanent cook on duty and the choice of meals was reduced. For people who came to the dining room to eat their meals we saw the atmosphere in the dining room was not convivial; it was noisy with the phone ringing and staff using the area as a thoroughfare.

Care plans showed people had not been consulted about their preferences and how they would like to receive the care they needed. We found the care plans were not up to date, did not reflect people’s current care needs and did not contain consistent information.

Park Lodge used a computerised system to maintain people’s care records and daily notes. We found the computer system was slow, difficult to navigate and extract information from. Staff confirmed the computer system was slow. The lack of prompt access to people’s records and the inaccuracies found meant there were risks a person’s may not receive the care they required and records might not be easily retrievable and located promptly should these be required.

The manager did not ensure that daily, weekly or monthly checks of the building and of maintenance certificates and housekeeping were carried out as required. This lack of oversight of the home meant that people were not always protected against the risks associated with the premises.

There were discrepancies in the recording of staff training and supervision which made it difficult to see if staff were being suitably supported in their roles. We did see the provider held staff meetings on a regular basis.

The provider had taken action to meet the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. But this information was not always clearly documented in people’s care plans and meant that staff might not be fully aware of existing restrictions on a person.

Despite the concerns we had about the service people at the home were mostly cared for by staff who were kind and respectful to people. We saw staff speaking kindly to people and assisting them in a calm manner. Staff knew who people were because they had taken the time to speak to, and get to know them. We observed the majority of the interactions between staff and people were positive. People received the privacy they needed and they were treated with dignity and respect.

We saw people and visitors had access to ‘How to Complain’ information which was on display and described the complaints process and the time frame for responses to a complaint. Records showed the complaints had been investigated and response letters sent to the complainants from the manager in a timely manner.

We found breaches of regulations in relation to the management of medicines, the cleanliness of the home, risks management, governance arrangements, meeting people’s nutritional needs, person centred care and care planning, staff support and management record keeping. We have taken action against the provider and will report on this when our action is completed

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

As a result of repeated breaches of regulations we have taken action against the provider according to our enforcement policy. We have removed the location Park Lodge from the condition of registration of the provider as of 12 April 2016. This effectively means that the provider is not able to lawfully provide a care service from Park Lodge.