Archived: Holyport Lodge Care Home

Holyport Lodge Care Home provides accommodation and nursing care to younger and older adults, people with sensory impairments or physical disabilities and people with dementia. The service provided ongoing care as well as respite stays. Part of the Bupa brand, the service is located in Holyport, a village near Maidenhead in Berkshire. The service is registered to accommodate a maximum of 40 people. On the days of our inspection there were 25 people who used the service.

The service must have a registered manager.

At the time of the inspection, there was 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.

At our last inspection on 27, 28 and 29 April 2016, we asked the provider to take action to make improvements regarding people’s consent, staffing deployment, staff training and support, people’s nutrition and hydration and the governance of the service and these actions have been completed.

Although we found further improvements were needed, the service had made positive changes and were sustaining positive improvement.

We made recommendations about staff deployment, communication with people and their families and the workplace culture.

People received safe care and treatment, although further improvement was required in staff deployment and medicines management. There were appropriate personal risk assessments in place for people’s care. People were protected from abuse and neglect.

Staff training and support had improved. There was a better focus on improving staff knowledge, experience and skills to provide good care for people. The service had achieved compliance with the Mental Capacity Act 2005 and associated practices. People’s nutrition and hydration was effective. Access to community healthcare professionals was available. A refurbishment plan had commenced to modernise the building.

Staff provided compassionate care. People and relatives were able to participate in care planning and reviews, but some decisions were made by staff in people’s best interests. People’s right to privacy and dignity was respected.

Care plans were detailed, personalised and reviewed regularly. There was a robust complaints system in place which included the ability for people and others to escalate complaints or report them to external bodies.

There was an increased focus on the safety and quality of people’s care. Systems and processes were examined more by the management to check for ways of improving the care experience for people. Staff felt the workplace culture of the service had improved.

At the time of the inspection, there was 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.

The location was last inspected under the 2010 Regulations on 28 May 2014, where the five outcomes we inspected were compliant. This is the first inspection of the location under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the time of the inspection, 29 people used the service and there were 59 staff.

People told us they felt safe living at Holyport Lodge Care Home. People were safe from abuse and neglect. Staff we spoke with were knowledgeable of how to act if abuse occurred and how to report this to managers or other authorities.

People’s risk assessments and care plans were comprehensive and detailed information required to provide the necessary care. Evaluations of the care took place although on some occasions these were not completed in a timely way. Some people were placed at risk of harm because evaluations of the care were not regular enough.

Proper maintenance of the premises and grounds was evident. The maintenance person was knowledgeable about risks from the building and completed assessments and coordinated repairs to effectively prevent harm to people. We made a recommendation regarding Legionella prevention and control.

People and relatives we spoke with told us staffing levels did not meet their needs. People’s common statement was that call bells were not answered in a timely manner. When we spoke with nursing staff and care workers, they also felt that staffing levels were not sufficient. We examined records about staffing deployment and observed staff performing their roles. We found times when staffing numbers meant people had to wait longer than they should. The service did not have safe deployment of staff.

The service had robust recruitment procedures and detailed personnel files. We made a recommendation that the service ensures staff have the right to work in the UK.

Medicines were not always ordered, stored, administered or recorded safely. This meant that people were at risk of medicines errors. In a previous inspection, we have found that the service was not meeting the regulation about medicines at the time.

Staff training, supervision and performance development required improvement. Although induction programmes and training had occurred, competency checks and repetition of training was needed to ensure effective care.

The service was not compliant with the requirements of the Mental Capacity Act 2005. People were deprived of their liberty without the required legal authorisation. The registered manager explained they were aware and that actions had commenced to remedy this issue.

People received nutritious food which they enjoyed. Hydration was offered to people to ensure they did not become dehydrated. However, there were some risks about malnutrition that were not detected by staff or the service. This meant people were placed at risk and some had lost weight without correct intervention from a multidisciplinary team.

People felt staff were caring and friendly. People were able to voice their opinion and the service listened to what their thoughts were. People had the right to choose or refuse and this was respected by staff. People’s privacy and dignity was respected during the care provision.

Responsive care was provided to people. Their wishes, preferences, likes and dislikes were considered and accommodated. Staff knew about the complaints procedure and people had the ability to complain. Managers investigated complaints and provided responses so that people knew their issue was recorded and where possible resolved.

The workplace culture at Holyport Lodge Care Home required improvement. There was a lack of continuity in managers over time and this had created a negative impact on people who used the service, relatives and staff. Although this point was recorded in the provider’s own documents, little action was taken to improve people’s experience. However, when we asked about the new manager, people and staff had positive feedback. We made a recommendation about workplace culture and continuous management.

A range of audits were conducted at the location. Some of the audits had been missed, however information was available about areas for improvement. Due to missing audits and some poor results from internal checks, people’s care was not of the quality they needed. The service had developed a plan to improve and was addressing issues. At the time of the inspection, additional support was given by area staff employed by the provider.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

As part of this inspection we spoke with the seven people who use the service, two visitors, the home manager and provider's quality control manager who was visiting the home on the day of our visit. We also spoke with two care staff, two registered nurses, the training coordinator and activity coordinator. We reviewed records relating to the management of the home which included, four care plans, daily care records, recruitment records of four staff and quality monitoring records used by the provider to measure the quality of the services provided.

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.

Is the service safe?

People's care plans detailed how the person wanted their needs to be met. Their risk assessments identified risks associated with personal and specific health related issues, and recorded guidance for staff to minimise those risks.

People told us they felt safe. They said they would have no hesitation to approach staff if they were worried about their safety or worried about the services provided. Staff had received training to recognise what constitutes abuse and action to take to protect people.

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. Relevant staff have been trained to understand when an application should be made, and how to submit one.

People's medicines were safely stored and were supported to take their medicines by trained staff. Audits were undertaken to monitor the safe use of medicines and to improve the processes.

Staff personnel records contained all the information required by the regulations. This meant the provider could demonstrate that the staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One person told us staff were: 'very helpful in every way, if you can't cope with something they are there. I get on very well with them'. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. A person told us: 'I feel I am looked after here'. A visitor told us: 'everyone here loves mum, I've seen mum with staff, good body language and sense of humour, and they all get on with her and don't just leave her sitting there'.

Is the service responsive?

People's needs had been assessed before they moved into the home. People told us staff discussed with them what was important to them. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People told us they were asked for their feedback on the service they received and that they had also filled in a customer satisfaction survey.

Staff told us they were clear about their roles and responsibilities and worked well as a team and spoke positively of the recent new manager in post. People told us the new manager and staff were approachable and that they felt listened to.

In this report the name of a registered manager appears who was not in post and not managing the regulated activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time of this inspection. The new manager told us that they would be submitting an application to the commission to become the registered manager of the home.

We spoke with people and thier relatives. Their feedback was positive and none of the people we spoke with expressed any concerns about medicines management.

There were processes in place to ensure that medicines were received, stored and administered safely. Only trained and competent staff were authorised to handle medicines. People who chose to manage their own medicine were supported to do so following a risk enablement assessment.

However, we determined the provider was in breach of the regulation because of the medication room and drug storage equipment, staff training pertaining to medicines and the documentation of people's medicines administration.

Most of the people we spoke with felt there was enough staff at the location. Two people told us they felt there were enough staff to meet their needs. Another person said at times they had to wait, but explained that not everyone could be attended to at the same time.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

People's care and treatment reflected relevant research and guidance. We saw that tools in the provider's documentation were in line with national standards.

People we spoke with told us they felt staff were suitably trained to carry out their role. One person said, 'They keep up the standards'. Another person told us that staff 'knew what to do' to look after them. None of the people who we spoke with had concerns about the abilities of the staff.

People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. People we spoke with told us they were involved in the way the service was operated.