Coneygar Lodge

Coneygar Lodge Home is a care home which is registered to provide personal care and accommodation to up to 22 people. The home specialises in the care of older people. At the time of the inspection there were 21 people living at the home.

We found the following examples of good practice.

Staff were committed to keeping people safe. They had undertaken additional training and understood the importance of wearing appropriate personal protective equipment (PPE). There were sufficient stocks available including masks, gloves, aprons and hand sanitiser. Sanitisation and PPE stations were placed around the service.

The service had appointed a dedicated lead in regards infection control, they supported staff to understand the importance of wearing PPE correctly. Staff were following good infection prevention and control practices which helped to minimise risks to people.

The service demonstrated a good understanding of when and how to access local infection prevention control (IPC) resources. For example, local health protection team or infection control leads, when they need advice and support. Whole home testing for COVID 19 was taking place.

Infection prevention and control audits took place and action plans were developed to follow up on any required actions. This ensured the registered manager had effective oversight of infection control measures.

Staff supported people and their relatives to understand the isolation processes and how the service could help to alleviate them feeling lonely, such as video calls with friends and loved ones. The service was in the process of setting up new visitor pods. A booking system was in place to support visitors in at a time that suited people and was spaced out to avoid potential infection transmission with other visitors. Visitors were being given access to gloves, masks, aprons and alcohol gel on arrival.

Further information is in the detailed findings below.

Coneygar Lodge is 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.

Coneygar Lodge is located in Bridport, Dorset. The home accommodates 22 people in four separate buildings situated around a courtyard, each of which has separate adapted facilities.

There are 22 single rooms, 21 of which are en-suite. All but three rooms are accessed from the ground floor. The three first floor rooms are accessed via stairs and there is a stair lift available. At the time of the inspection there were 22 people living at the service.

There was a registered manager in position. 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 was exceptionally well led. The service benefitted from strong leadership. The registered manager was passionate about providing person centred care and this was reflected in every aspect of the service. The registered manager worked in partnership with other organisations and had taken part in several good practice initiatives designed to further develop the service. They were enthusiastic and committed to providing the best service possible. Their focus included the promotion of dignity and valuing people's diverse needs to provide a very high standard of person centred care.

There was a 'whole team' approach which was the driving force in delivering a truly person centred service. Staff who had shown interest in specific areas, such as infection control medicines and end of life were designated 'Champions'. These champions played an essential role in developing best practice, sharing learning and acting as role models for other staff. An end of life champion told us their role was to, “Oversee what was happening and gently guide staff to what we should be doing in response to the wishes of the resident and their family".

People said they felt the service was extremely responsive to their needs. People who used the service received highly personalised care from staff who knew their background, interests and hobbies. People were encouraged to pursue individual interests and establish new community links and friendships. The registered manager listened to people who used the service and about what they wanted in regards to activities. Staff had an excellent understanding of people's needs and were imaginative in the way they provided person centred care which put people at the heart of the service. They did this by empowering people to reconnect with past interests, making people feel valued and enabling them to “live life to the full” again.

There were a range of social activities taking place. The registered manager told us, “We are proud of our activities, we take time to find out people’s individual interests so we can support them to remain as active and interested as possible. The art group are making amazing progress.” People told us they had been consulted in regards past interests and employment. They told us where they had shared their past experiences they had been encouraged to explore and “Take up” previous interests.

One initiative had been to involve people in past interests such as painting. People were introduced to a local artist and encouraged to join an art workshop. People showed us their art work and told us of their love of art and how they had, “Loved being able to take up that interest again. “I did not think I would ever paint again, it has given me a new lease of life.”

The service has taken innovative steps to meet people’s information and communication needs over and above complying with the Accessible Information Standard, particularly in using technology to ensure records were accessible to people with different communication needs.

People’s communication needs were clearly assessed and detailed in their care plans. This captured the persons preferred methods of communication and how best to communicate with them. Staff told us how they communicated with one person in a way which was appropriate for them, and how they supported another to regain their love of reading by purchasing a projector for them. The person told us, “It has changed my life, and enabled me to pursue my greatest interest”.

There was a strong person centred culture to the service. Staff were compassionate, kind and caring and had developed good relationships with people using the service. People were comfortable in the presence of staff, and told us they were treated with dignity and respect. We received very positive comments from a range of people about the caring nature of the service. One person wrote to the local paper in regards their experience of ‘kindness and compassion from staff. Another told us, “I never thought I could be happy again. But I have found peace and happiness living here. It is like I have a lovely new family.”

Care plans were person centred and contained the relevant information staff needed to ensure people’s needs were met. Staff used their knowledge of people’s life histories to help them understand what was important to each and every person. There was a positive culture of ensuring that people maintained their independence. One person told us they had been “Very worried” they may not be able to remain living at the service due to changes in health, but felt the staff “Had gone the extra mile “to support them to stay there.

End of life discussions had taken place and people had advanced care plans in place. The registered manager and staff were committed to providing people who used the service with the best end of life care they could possibly give and provide support to families and friends at this time.

People were safe because there were systems and processes in place to protect them. Risk assessments were in place and these promoted people's safety such as walking around the service. Incidents such as falls, and medicine errors were used as an opportunity for learning and to help drive improvements. Staff were aware of how to keep people safe and able to explain how they would identify signs of possible abuse. Staff told us they were aware of their responsibilities to raise any safeguarding concerns.

Medicines were administered, recorded and stored in a safe manner and all staff who administered

medicines had received suitable training to do this.

Staff were subject to checks on their suitability before they were offered employment. Enough staff were employed to ensure that people's needs could be met in a timely manner. People and their relatives told us they felt there were enough staff to keep them safe.

People received an effective service and were supported by staff who had received appropriate training. 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 were aware of infection control measures and the service was clean and well maintained. There were numerous posters around reminding people, their visitors and staff of the importance of personal hygiene, such as hand washing.

The registered manager understood their responsibilities and worked with people who used the service, relatives, staff and the provider to improve the quality and safety of care that was provided. Quality assurance procedures and a programme of audits were in place. There was a strong emphasis on continuous improvement to drive up the quality of service provided at the home.

Coneygar Lodge is a residential home in Bridport which provides support for up to 22 people. They had one vacancy at the time of our inspection. The home is set around a courtyard and accommodation is in four separate buildings. All rooms are en-suite and each building has use of a communal area. People are able to use communal areas in any of the four buildings and all bedrooms have a wireless call bell in place. Most rooms are on the ground floor, rooms on the first floor have stairs and a stairlift for access. The home has a garden and a courtyard which are accessible to people.

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.

Staff were aware of how to keep people safe and able to explain how they would identify signs of possible abuse. The service had the local safeguarding policy and looked at the training records which showed that all staff had received safeguarding training.

Staff understood the risks affecting people and their role in reducing these risks. For example, one staff member told us about people who were at risk of falls and that they supervised them walking. They also said that “some residents request (us) to walk with them for confidence”.

People and visitors felt that there were enough staff to support people. One person told us “every time I’ve wanted something, they’ve been there”. Another said that staffing was “generally adequate, although (they are) sometimes busy at night time”. Another said “they come quite quickly when I call”.

Medicines were stored safely and given as prescribed. The service used an electronic Medicine Administration Record(EMAR) to give medicines to people. Staff with appropriate training gave medication and were able to show us how the system supported them to make sure medicines were given as per peoples prescription.

Staff were knowledgeable about the people they were supporting and received relevant training for their role. Supervisions were a mixture of face to face meetings and observational sessions where the registered manager observed staff in their role.

People were supported within the principles of the Mental Capacity Act 2005 (MCA). Staff had received training in MCA and were able to tell us how they supported people with decision making and explain the principles of the MCA and how they considered these when supporting people.

People, visitors and staff all told us that the food was good. There was a chef on the staff rota every day and we saw examples of the menu choices available for people.

Staff told us that information about people was passed to health professionals quickly when needed. One person said “if (someone was) unwell, I would speak to the shift leader to ensure it was passed to a health professional”.

People and visitors told us that the service was caring. One person said that staff were “considerate and seem to know what you want”. Another person said that they didn’t “need to ask them, they know what I need”. Staff were attentive to people and understood their individual needs.

People told us they had choices about their care. One person said “I decide when I get up and when I go to bed”. Another told us “ I go to bed early and listen to my radio and stay up for TV sometimes”. We looked at peoples care records and saw that their preferences were recorded.

People were not aware of advocacy services. We saw that the statement of purpose for the service included details about advocacy. However people, visitors and staff were not aware about these services. We spoke with the registered manager who immediately contacted the local advocacy service and requested information to distribute to people.

Visitors were welcomed at the service. One person told us “they do come whenever you want, no visiting times and they could stay for a meal if they wanted”. Another person said that visitors “come in whenever and stay whenever”.

Team meetings happened regularly and staff had input into the agenda for what was discussed.

People were involved in planning and reviewing their care, these were signed by them and their relatives.

The service had an activities co-ordinator who planned and arranged the weekly activities for people. The registered manager told us that the co-ordinator had spent time with each person, discussing what interests they had and what activities they may wish to be available. There was a wide range of activities including music and movement, memory boxes and one to one time.

The proprietor took a very active role within the home and there was a registered manager in post. People told us that the manager was approachable. One said “they come to see me every day, I think they are very, very nice”. Another told us “they would come and see me if there was anything wrong”.

Staff were aware of how to whistleblow and one told us that they would “be confident to do so”. We saw the service policy for this and saw that it laid out the procedure for staff to follow.

Staff were confident in their role and there was an open culture. One told us that management were fair in their approach and another said that they would be “confident to report a mistake and that they would be fair”. Staff also told us that they received feedback from the management.

Audits of the service, including care plans, infection control, cleaning and fire safety were carried out regularly. Audits were comprehensive and included actions planned to take forwards and further develop best practice.

Our inspection on 15 December 2012 found that medicines were not always recorded and stored safely. The provider wrote to us on 14 February 2013 and told us that they had made improvements. During this inspection we found that sufficient improvements had not been made.

The medicines refrigerator was used to store urine samples and handwritten entries onto the Medication Administration Record (MAR) were not always signed by two members of staff to confirm accuracy. The storage and recording of

controlled drugs had improved since our last inspection.

People's care needs were assessed and care and support was provided to meet people's assessed needs. One person told us, 'I think it's excellent. I am not short of anything I need. If I am I ring the bell and they sort it for me.'

People were not always protected from the risks associated with the management of medicines as appropriate arrangements for the storage and recording were not made.

People were supported and cared for by skilled staff. One person told us, 'They look after us well. We couldn't do without them.'

The quality of the service was regularly assessed and improvements were made as a result. The provider had an annual program of quality monitoring activity including audit and survey.

In this report the registered manager, Natily Berry, appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.