About the service Washington Lodge is a nursing home which provides nursing and personal care for up to 64 people, some of whom are living with dementia. There were 51 people living there at the time of this inspection.
People’s experience of using this service and what we found
Systems were in place to monitor the quality and safety of the service, but these were not always effective in identifying issues with staff practices or the operation of the service.
Medicines were not managed safely, and improvements were needed in relation to the recording documents used to support safe medicines management.
Staff recruitment procedures needed to be strengthened to ensure staff were employed safely. We discussed with the registered manager where refinements could be made to the audit systems for recruitment to ensure all necessary information was obtained.
The provider had recently reviewed the induction process for agency staff and identified improvements needed to be made. We found the new induction records needed to be further enhanced.
Overall people were protected from harm as risks had been assessed and plans put in place to mitigate these. However, these needed to be developed and extended to cover how to support individuals and those around them when people displayed behaviour, which may challenge.
Care staff, in general, adhered to COVID-19 guidance on working in a care setting. Staff had undertaken training in putting on and taking off PPE, but this needed to be refreshed.
New care records had been developed but these needed further work to ensure they supported staff to work with people who had more complex needs.
There were enough staff on duty and additional staff were available to provide one-to-one support for people when this was needed. Agency staff, particularly nurses were regularly used. Relatives found this led to a lack of consistency in care. The provider was working to recruit permanent staff to cover the vacancies.
Generally, relatives felt the care was safe and staff were compassionate. People were happy at Washington Lodge. People were protected from abuse by staff who understood how to identify and report any concerns. Interactions between people and the staff team were very positive and relatives also said they were made very welcome at the home. People were treated with kindness, dignity and respect.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 4 February 2018).
We completed a targeted inspection of this service 8 March 2021 looking at infection prevention and control measures. We were assured the provider had appropriate measures to manage the risks posed by the COVID -19 pandemic.
Why we inspected
We received concerns in relation to the management of medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.
We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Washington Lodge on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.
We have identified a breach in relation to regulation 17 (Good Governance). The breach concerned the management and monitoring of the service.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.