We completed this unannounced inspection on 13 July 2017. OSJCT Patchett Lodge can provide accommodation and personal care for 30 older people. There were 22 people living in the service at the time of our inspection.
The service was run by a charitable body who was the registered provider. At this inspection the company was represented by an area operations manager. There was a registered manager in post. 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. In this report when we speak both about the charitable body and the registered manager we refer to them as being, ‘the registered persons’.
At our last inspection on 22 December 2015 we found that a number of improvements needed to be made to ensure that people consistently received a safe and responsive service. The improvements included making sure that medicines were administered in the right way. This entailed care staff checking that people were taking medicines that had been given to them. It also involved making sure that when patches were used to administer medicines they were placed on different areas of a person's skin. This is necessary so that the patches do not result in people developing sore skin. In addition to these shortfalls, we also found that people needed to be offered more opportunities to enjoy participating in social activities. At this inspection we found that each of these particular concerns had been addressed.
However, at this inspection we also found that other concerns needed to be addressed. We noted that full background checks had not always been completed before new staff were employed. In addition, we found that on four recent occasions staff had not correctly recorded each occasion when a medicine had been dispensed. A further concern was that care staff had not received all of the training the registered persons considered to be necessary. Furthermore, some of them did not have all of the competencies they needed including knowing how best to support people to have enough hydration. In addition, there were shortfalls in the arrangements used to ensure that people always had enough to drink. The shortfalls had resulted from care staff not consistently following the registered persons’ procedures that were designed to ensure that people always had enough hydration. Although in practice people had received the support they needed to drink enough, oversights in following agreed procedures had increased the risk that this assistance would not be reliably provided. We also concluded that more robust quality checks were needed to enable problems to quickly be put right. These included more promptly addressing defects in the accommodation.
Our other findings were that care staff knew how to safeguard people from situations in which they might experience abuse, there were enough care staff on duty and people had been helped to avoid preventable accidents. In addition, people had been assisted to receive all the healthcare attention they needed.
Whenever possible people had been helped to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had ensured that people only received lawful care.
Care staff were kind and compassionate. People’s right to privacy was promoted and confidential information had been kept private.
People had been consulted about the care they wanted to receive and were given the practical assistance they needed. Care staff promoted positive outcomes for people who lived with dementia and there were arrangements to quickly resolve complaints.
People had been invited to contribute to the development of their home. Care staff considered that the service was run in an open and inclusive way so that they were able to speak out if they had any concerns.