Archived: Heath Lodge

Updated 7 April 2017

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 inspection took place at Heath Lodge on 31 January 2017 and was unannounced. The inspection was carried out by two inspectors, a specialist nurse advisor whose specialism was people living with dementia and an expert by experience. An expert by experience is someone with personal experience of having used a similar service or who has cared for someone who has used this type of care service.

Before the inspection we reviewed information we held about the service including statutory notifications that had been submitted. Statutory notifications include information about important events which the provider is required to send us. We reviewed a copy of the action plan sent to us by the provider that told us how they would meet the legal requirements. We reviewed copies of regular monitoring audits we received from the provider, alongside reports from the local authorities serious concerns meetings held in partnership with the provider that set objectives to discuss and improve performance in the home. We reviewed the findings of a service monitoring audit carried out by the local authority and sought additional feedback social care professionals who supported people living in Heath Lodge.

During the inspection we observed staff supporting people who used the service; we spoke with 13 people who used the service and relatives of two people. We spoke with 10 staff members, the manager, the newly appointed regional manager, the provider and two visiting health professionals.

We also used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We reviewed care records relating to seven people who used the service and other documents central to people's health and well-being and associated management records.

Updated 7 April 2017

We inspected Heath Lodge on 13, 14 and 16 January 2015 and identified breaches around the following areas, person centred care, obtaining consent, good governance and staffing levels. We rated the home as requiring improvement. We carried out a comprehensive inspection of Heath Lodge on 16 and 25 May 2016. We found continuing breaches of what we previously found, but at this inspection identified concerns around promoting peoples, providing care in a safe manner, protecting people from abuse, and effectively managing people’s nutritional needs. We took action using our regulatory powers and urgently imposed a restriction to ensure Heath Lodge took no further admissions. We also placed the service in Special Measures and kept the service under review along with referring our findings to the local authorities safeguarding and commissioning teams.

We carried out a comprehensive inspection Heath Lodge on 31 January 2017, this was unannounced. At this inspection we found that although they had made some improvements, there were still areas that needed further improvement and some areas that remained in breach of regulation. These were in relation to staffing, consent and dignity. You can see what actions we have asked the provider to take at the back of this report.

Heath Lodge is registered to provide accommodation and personal care for up 67 older people some of whom live with dementia. At the time of our inspection 34 people were living at the service.

Since our last inspection there had been continued changes within the senior management team. The manager who was registered at Heath Lodge had been transferred to another home owned by the provider however had not submitted their application to cancel their registration. A new manager had taken up the post from November 2016, and was in the process of registering. 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.

People did not experience delays whilst waiting for their care to be provided, however staff were rushed when completing tasks. The manager had recruited a significant number of staff to the home and also performance managed a number of staff out of Heath Lodge as they were not working in a way that ensured people received a satisfactory level of care. They had reduced the number of temporary staff working in the home to negligible levels. People’s care plans had been developed to include more up to date information. However, these records still required work to ensure they included all specific information about people's needs and staff did not always read them prior to carrying out care. People’s medicines were managed safely and people received their medicine as the prescriber intended.

The provider had not ensured there was effective, well trained and supported leadership on each of the floors of the home. Care staff had not all had the training required, and staff had not received regular supervision of their conduct or practise. People's consent was sought however the service did not consistently work in accordance with MCA and DoLS legislation. People were happy with the food and drink provided to them and where people were at risk of weight loss, staff took appropriate actions. People were supported by a range of health professionals.

Individual staff members spoke and interacted with people in a kind and friendly manner, and none of the staff observed lacked a caring approach to people. However staff did not always ensure people's social needs were met. People felt able to raise a concern or complaint with staff who they felt would take appropriate action to resolve these. People were provided with regular opportunities to meet so they could discuss improvements in the home or be kept abreast of developments.

People did not always receive high quality care that was well led. The action plan submitted to us following our previous inspection had not been completed and issues identified following local authority reviews of the care had also not been completed. Care records and records relating to the management of the service were incomplete. Staff felt the manager involved them in discussions about the running of the home; however people felt the manager was not always visible.