Background to this inspection
Updated
13 December 2016
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.
The inspection took place on 19 and 20 October 2016 and was unannounced.
The inspection team consisted of two adult social care inspectors from the Care Quality Commission (CQC).
Before commencing the inspection we looked at any information we held about the service. This included any notifications that had been received, any complaints, whistleblowing or safeguarding information sent to CQC and the local authority. We also spoke to the quality assurance team at Wigan Council.
Before the inspection, the provider completed a Provider Information Return (PIR). 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.
During the course of the inspection we spoke to the registered manager, clinical lead, a nurse, five staff members, activity coordinator and head cook. We also spoke to six people who lived at the home and two visiting relatives.
We looked around the home and viewed a variety of documentation and records. This included six staff files, eight care plans, Medication Administration Record (MAR) charts, policies and procedures and audit documentation.
Updated
13 December 2016
We carried out an unannounced inspection of High Peak Lodge on 19 and 20 October 2016.
High Peak Lodge is registered to provide personal and nursing care for up to 39 people. It is situated close to Leigh town centre. All the rooms are for single occupancy and have en-suite facilities. There are gardens to the front and rear of the home and car parking is available. At the time of our inspection there were 27 people living at the home.
The home was last inspected on 18 and 19 February 2016, when we rated the service as ‘inadequate’ overall and identified six breaches of four of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to staffing; safe care and treatment; person-centred care and good governance.
Prior to the last inspection in February 2016 we became aware of serious concerns with how the service was managing the needs of people at risk of pressure sores. During the inspection we saw that whilst the home had taken steps to address these concerns, there were still issues with the monitoring and documentation around pressure care and use of specialist equipment.
In June 2016, the Police commenced an investigation into concerns about the care and support received by a person using the service up to their death; this investigation remains on-going.
At this inspection we found the service had made improvements and was now meeting all regulatory requirements. We did not identify any current concerns with the care provided to people living at the home.
At the time of the inspection the home had a 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.’
We saw the home was clean and had appropriate infection control processes in place. Five housekeepers were employed, one of whom was a supervisor who oversaw completion of the daily and weekly cleaning schedules.
People we spoke with told us they felt safe. Similarly relatives had no concerns about the safety of their family members and were positive about the level of care provided. The home had appropriate safeguarding policies and procedures in place, with detailed instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.
Staff and people using the service commented on the improvements in staffing levels and felt that the home had enough staff to meet people’s needs. The service was continuing to recruit additional staff, particularly nurses in order to remove the need for any agency staff on night shifts.
Both the registered manager and staff we spoke to demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We saw the service was working within the principles of the MCA and had followed the correct procedures when making DoLS applications. Although the majority of applications made were still awaiting assessment, the service had ensured on-going contact with the local authority had taken place, to request feedback on when these would occur.
We saw medicines were stored, handled and administered safely and effectively. All necessary documentation was in place and was completed consistently. Staff responsible for administering medicines were trained and had their competency assessed annually. Sterile water used for Percutaneous Endoscopic Gastrostomy (PEG) flushes along with thickening agents, which are used to thicken fluids, were stored securely in a locked cupboard in the dining area.
Staff spoke positively about the training available and confirmed that statutory sessions were refreshed on an annual basis. We saw all the staff had completed an induction programme, new staff had been enrolled on the care certificate and on-going training was provided to ensure skills and knowledge were up to date.
Staff confirmed they received regular supervision and annual appraisals, which along with the completion of monthly team meetings, meant they were supported in their roles. Staff were actively involved in the supervision process and the home had recently introduced out of session tasks linked to the supervision process. These focussed on challenging poor practice.
Observation of meal times showed these to be a positive experience, with people being able to make choices about where they sat and what they ate. Staff encouraged people to use the dining room, in order to promote engagement and involvement but abided by people’s wishes. Drinks and snacks, including fortified foods, were available in the lounge throughout the day and people were supported and encouraged to drink on a regular basis, with detailed monitoring in place.
Throughout the inspection we observed positive and appropriate interactions between the staff and people who used the service. Staff were seen to be caring and treated people with kindness, dignity and respect. Both people who used the service and their relatives were complimentary about the attitudes of the staff and the standard of care received.
We looked at six care files which contained detailed information about the people who used the service and how they wished to be cared for. Each file contained detailed care plans and risk assessments, which helped ensure their needs were being met and their safety maintained.
The home employed an activity co-ordinator and had sourced specific training for other staff to enable them to provide activity support. Everyone we spoke with was positive about the activity options available. We saw the activity schedule catered for all interests and abilities and people were actively encouraged to participate in any way they could.
The home had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed on a daily and monthly basis and covered a wide range of areas including medication, care files, infection control, health needs and the overall provision of care. We saw evidence of action plans being implemented to address any issues found.