Lennox Lodge

We found the following examples of good practice.

There had been an outbreak of Covid-19 affecting three people. During that time people were supported to isolate in their bedrooms and at the time of the inspection the isolation period had passed. The registered manager had followed government guidelines relating to visiting throughout the pandemic.

The registered manager had successfully implemented zoning at the home which had enabled those who tested positive for the virus to be looked after on a self-contained floor of the home. The home is split across three floors and separate dining areas had been created on each level. This further supported zoning and minimised the amount of people eating together at any one time.

We saw staff wearing personal protective equipment (PPE) appropriately. Staff had a dedicated entrance and exit area to the home and a room where they had their temperatures taken, changed into their uniform and put on PPE. Shifts had been staggered to reduce the number of staff starting and ending their shifts at any one time. PPE had been colour coded to make it clear to others who staff members were caring for. For example, staff wearing blue masks were looking after covid-19 free areas and those wearing red were looking after those who were being supported to isolate in their bedrooms. Staff remained dedicated to one area of the home. We saw several PPE stations across the home with bins for disposal of used items.

Several people at the home lived with dementia and the registered manager told us that the pandemic had had a negative effect on some people. To help reassure and support people the registered manager had over staffed the home for every shift. This allowed staff to spend more one to one time with people, talking to and reassuring them and helping them with activities. The home had purchased several iPads and people were helped to speak to their loved ones through video calls and facetime.

The home was clean and some ornaments had been removed to minimise cleaning areas. A dedicated cleaning regime was followed daily and all staff took their turn with cleaning duties. This enabled seven day a week cover and cleaning taking place on every shift. Cleaning regimes included high reach areas and frequently touched areas for example, door handles and tabletops. Windows were kept open whenever possible and during the winter extra heaters had been purchased to keep the home warm whilst allowing ventilation. This process had been risk assessed and the home maintained a comfortable temperature throughout.

All staff had completed training and refresher training in PPE, infection prevention and control and Covid-19 awareness. The registered manager was a visible presence across the home and used time to speak to staff and regularly check their knowledge of PPE and infection control procedures.

Lennox Lodge is a residential care home providing personal care for older people, male and female, some of whom are living with dementia. The service can support up to 27 people and at the time of the inspection there were 23 people living at the home.

People’s experience of using this service and what we found

People told us they felt safe and were protected from abuse and harm. Staff had received safeguarding training and were able to tell us what constituted abuse and what steps they would take if needed. Staff were aware of the whistleblowing policy. Accidents and incidents were reported and learning taken forward. Fire and other safety checks had been completed and evidence was seen of regular reviews. Risk assessments relevant to people were in place and people were supported safely with their medicines.

Staff training was documented and was up to date. Staff had asked for additional training in some areas and the registered manager had facilitated this. A thorough induction process was in place which involved shadowing more experienced staff members. Staff support continued through regular supervision meetings. People were supported to access health and social care professionals and were supported to maintain a healthy diet. Mental capacity assessments and best interest meetings had taken place where necessary.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were treated with dignity and respect and staff were kind to people. A relative said to us, “The staff are brilliant. I don’t know how they do it.” Another relative said, “It is towards the end of her life but it’s like the beginning of a new life for her.” Staff understood people’s day to day care and support needs. People were treated with respect and were encouraged to be independent. People’s privacy and dignity were supported.

The registered manager knew people well and care was person-centred. People were supported to go out on local visits and to use the garden. A variety of activities were available to people to join in with either in a small group or individually. A complaints policy was in place and everyone knew how to raise issues which were then dealt with in a timely and appropriate way. Staff were trained in end of life care and were supported by the registered manager.

The registered manager and staff demonstrated a positive culture and the home was friendly and welcoming. Auditing processes were in place and any trends or errors could be identified and addressed. A new computer system assisted with this process by, for example, sending an alert when medicines had been refused or were late. The home had a positive relationship with professionals that visited the service such as GP’s and district nurses.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

Good. (Report published 30 December 2016)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Lennox Lodge provides accommodation and personal care for up to 30 older people. On the day of our inspection there were 24 people living at the home.

There was a new manager at the home who was completing the process of registering with The Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 and their relatives said they were happy with the support staff provided. They told us staff were caring and promoted people’s independence. People told us they were able to maintain important relationships with family and friends. We saw people had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. They were supported in a discreet and dignified way. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them. People told us they had access to health professionals as soon as they were needed.

Relatives we spoke with said they felt included in planning the support their relative received and were always kept up to date with any concerns. People living at the home were able to see their friends and relatives as they wanted. They knew how to raise complaints and felt confident that they would be listened to and action taken to resolve any concerns. The manager had arrangements in place to ensure people were listened to and action could be taken if required.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. Staff had up to date knowledge and training to support people.

We saw staff treated people with dignity and respect whilst supporting their needs. They knew people well, and took people’s preferences into account and respected them. Staff respected people's rights to make their own decisions and choices about their care and support. People's permission was sought by staff before they helped them with anything. When people did not have the capacity to make their own specific decisions these were made in their best interests by people who knew them well and were authorised to do this.

Staff met people's care and support needs in the least restrictive way. When it was identified that people received care and support to keep them safe and well which may be restricting their liberty applications had been made to the local authority for authorisation purposes.

The manager promoted an inclusive approach to providing care for people living at the home. People who lived at the home and staff were encouraged to be involved in regular meetings to share their views and concerns about the quality of the service. The provider and manager had systems in place to monitor how the service was provided, to ensure people received quality care.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. We spoke with four people who lived at the home, three relatives who were visiting, and four members of staff. We also spoke with a GP and the hairdresser.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found

Is the service safe?

We found that the environment was safe, clean and hygienic. The home was bright and airy and the corridors were uncluttered and well lit. Medicines and cleaning equipment were all kept in locked cupboards. We looked at a number of care plans and found that they contained the relevant information about lifestyle, medical history and assessments of risk. Accidents and incidents were reported and appropriate action was recommended to improve safety.

There were sufficient appropriately trained staff on duty and we witnessed a helpful handover between their shifts.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

The home had systems in place to assess and manage risks and to provide safe and effective care. The staff were appropriately trained and training was refreshed and updated regularly. Staff could also take the opportunities provided to study for additional qualifications and to develop their understanding of caring for people with conditions such as dementia and Parkinson's disease. We also found evidence of staff seeking advice, where appropriate, from the GP or social services.

Is the service caring?

People told us that 'the home is very friendly and everyone wants to help'. One relative we spoke with said 'it is homely and not at all clinical'. We spoke with relatives who said they were able to visit at any time and they were 'made to feel very welcome'. We saw that the staff were kind and sensitive and took time with people over lunch and when they were moving about within the home. We observed high levels of respect and people were treated with consideration and dignity.

We spoke with two people who were living in the home and both were positive about the care they received. One said 'the carers are excellent, all of them are lovely; I can't fault them."

Is the service responsive?

People's needs were assessed before they moved into the home and detailed care plans and risk assessments were maintained and reviewed regularly. We saw that the staff monitored weight, nutrition and hydration and handover sessions were helpful and informative. Call bells were answered according to the home's procedure and people had access to a programme of activities.

They were able to choose dishes from the menu and the chefs were happy to provide for special diets and additional options as requested. People living in the home also engaged with the manager and staff at regular meetings where they could express their views about all aspects of life at the home. They told us that their feedback was acted upon by the manager.

Is the service well-led?

People told us they were asked for their feedback on the service and their feedback was heard and changes were made as a result. One person had asked for a particular cake with the afternoon tea and that had been provided. We saw copies of the questionnaires completed by the people living in the home, their relatives and other healthcare professionals. We saw that incidents and accidents were reported and appropriate action was taken to prevent a repetition. The manager conducted a series of internal audits and took action promptly to resolve any issues.

We spoke with ten people and seven staff. One person told us, 'The staff are really very good, very supportive.'

We found that people were shown respect and dignity. There was a range of activities for people to engage with.

We looked at three care plans and saw that they reflected the care that was provided to people. The home had systems in place to ensure people's individual needs were met.

We found the found to be clean and tidy. One person told us, 'My room is cleaned regularly.'

The home had effective staff recruitment systems in place.

The home had an effective complaints system. People we spoke to were aware of how to make a complaint.

Records viewed indicated that staff were appropriately recording incidents and accidents and, in discussion, they demonstrated an awareness of their safeguarding responsibilities.

We viewed all areas of the home. We checked that all outstanding improvement works had been completed. We found the home was maintained to a good standard, and records viewed supported this.

We spoke with three staff in addition to the manager. Staff confirmed they received some supervision. However, records viewed indicated supervision was primarily used to review individual training needs. Staff said their training was kept updated and records viewed supported this.

Staff reported that communication was good and they were kept updated through several sources. Staff meetings were held approximately twice per year, more if needed. One staff member commented the home was a happier place to work. They said the support and structure for staff had improved since the appointment of the new manager.

Auditing and monitoring systems had been introduced to highlight and address shortfalls. People in the home, relatives and other professionals were routinely asked for feedback, and any issues were addressed on an individual basis.