Worsley Lodge

Updated 16 November 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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.

The inspection was undertaken on 25 and 27 September 2018. The inspection team consisted of one adult social care inspector from the Care Quality Commission (CQC) and one expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert who attended this inspection had experience in older adult’s residential and community care and dementia care.

The inspection was undertaken to check improvements had been made following our last inspection on 31 January and 1 February 2018. Prior to the inspection we reviewed information we held about the home in the form of notifications received from the service, including statutory notifications and any safeguarding referrals submitted by the service.

Prior to this inspection we did not request a Provider Information Return. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.

We looked at a selection of records the home maintained including; policies and procedures, the recruitment records of four staff three of whom had been employed since the last inspection, the care records of six people, supervision and training records, staff rotas and other records relating to quality and audit checks completed by the service. We spoke with; seven people who lived in the home, three of their relatives and seven members of staff which included night staff, care staff, a senior and deputies.

We used the Short Observational Framework for Inspection (SOFI), which is a way of observing care to help us understand the experience of people who could not talk with us. We observed two lunch and two breakfast services. We spent time in communal areas observing how care was provided.

Updated 16 November 2018

We last inspected Worsley Lodge, in January 2018, when we identified multiple breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in relation to; safe management of medicines, managing assessed risks, meeting nutritional needs, staffing and good governance. Two of the five breaches had been identified in a previous inspection. The home were rated 'Inadequate' in two key questions, Safe and Well led, 'Requires Improvement' in effective and 'Good' in Caring and Responsive. The overall rating for this provider was 'Inadequate' and the home was placed into 'special measures' by CQC.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the three key questions to at least good. The provider subsequently submitted action plans to CQC on a regular basis. The provider had regular meetings with Salford quality assurance team to monitor progress and to review the action plan. We found there had been significant improvements in two key questions but further improvement was still needed in relation to the key question Well led. This was because the registered manager still needed to embed effective systems to sustain the improvements achieved in the service and to develop further oversight of records.

Worsley 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. The home can accommodate a maximum of 48 people. When we inspected there were 39 people living at the home, some people were living with dementia. Accommodation was provided over two floors in single rooms, 33 rooms were en-suite. There was a lift. There were a variety of communal areas for people to access which included quieter areas for people who preferred this. There were extensive gardens with a variety of furniture which people could access directly through one of the lounges downstairs.

Since the last inspection the home manager had successfully applied to CQC to be the 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.

People living in Worsley Lodge and their relatives told us they felt safe in the home. At our last inspection we had found the service had failed to manage some of the assessed risks they had identified, a small kitchen door had been propped open which had exposed some people to the risk of scalding. At this inspection we found there had been an improvement. The door was not propped open unless a member of staff was present to maintain people's safety. At the last inspection fire escape signage had been removed from the first floor and not replaced in a timely way. Shortly after the last inspection this had been replaced to ensure people knew where their nearest fire exit was.

Medicines had not been managed safely. Some medicines had been out of date, stocks were not accurate, records were incomplete and we could not be confident people had received time sensitive medicines or topical treatments when required. Since the last inspection the home had worked with the quality assurance team pharmacist to improve their medicines procedures and records. At this inspection we found this had been significantly improved and were confident medicines were being managed safely.

At the last inspection we found staffing levels had been low, staff had been very rushed and found it difficult supervise vulnerable people. This was reviewed during the last inspection and increased. This increased level remained in place and a further increase had happened since then.

People continued to be protected from the risk of harm and abuse by staff who were knowledgeable about what might be a safeguarding concern and how to raise this. The home had raised safeguarding matters however, there had been some concern expressed by the local safeguarding team about how quickly the home had responded to their requests for information during a recent safeguarding investigation.

Risks associated with peoples care and support needs had been assessed and plans developed to minimise the potential for harm. Risk assessments had also been completed in relation to the premises and equipment. These had been reviewed and updated when required.

People were protected from the risk of infection. Staff were observed to use personal protective equipment such as gloves and aprons when providing personal care.

People's needs were assessed prior to them moving into the home, this ensured the service was confident they could meet the persons needs.

People received support from trained staff who had the appropriate knowledge and skills to support them. At the last inspection we found induction training for agency staff had not been effective and the home had been in breach of the regulations relating to staffing. At this inspection we found this had been addressed fully.

At the last inspection we found people had not received effective support to maintain their nutritional needs. Records had not been completed and care plans had not been updated to reflect changes. The home had been in breach of the regulations in relation to meeting people's nutritional needs. At this inspection we found this had improved significantly.

People received a variety of food and drink throughout the day. People we spoke with told us they thought the food was good or alright. No one told us they did not like the food.

People were supported to maintain their health and wellbeing. Records in care plans showed people had regular screening and were supported to access health professionals when required.

The home continued to support people in kind and caring ways. We observed staff throughout the inspection and saw they took their time to respond to people and reassure them. Staff were seen to be skilled at maintaining peoples' dignity and promoting choice and independence.

People continued to receive personalised care that was responsive to their needs. Care plans included details of the person's history, background, cultural identity and preferences. Reviews were held regularly and plans updated to reflect any changes to a persons needs or wishes. People and their relatives had been involved in reviews.

There was a complaints policy and we could see how the home had followed this in relation to complaints received.

People were supported at the end of their lives to have as dignified and pain free death as possible. People had been supported to have discussions about this aspect of their care and to consider their wishes.

Staff who worked at Worsley Lodge told us they felt the home was well managed. Some people identified specific improvements that had been made since the last inspection. One of the relatives we spoke with also praised the management team.

We looked at the governance systems in place to see whether auditing and monitoring systems had improved. At the last inspection we had found audits and walk around checks had not been consistently completed and some had failed to identify the issues we had found. This meant the home were in breach of the regulations in relation to governance. At this inspection we found there had been significant improvements in the frequency and scope of audits. However, some records were not readily available during the inspection and the local safeguarding team had found it difficult to obtain up to date information in a timely way to inform their investigation. Further improvement was needed in this area.