This inspection took place on the 5 and the 9 February 2015 and was unannounced.
Cambrian Lodge provides accommodation and personal care for up to 28 older people. Some people living at the home were living with dementia which means their ability to understand and communicate their needs and wishes was limited. Most people were dependent on the staff to meet all of their care needs. At the time of our inspection there were 20 people living at the home.
Cambrian Lodge is large converted villa in a residential area of Portishead. The accommodation is over 4 floors which is accessed via two lifts and a staircases.
A registered manager was 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At the last inspection carried out on the 17th and 18th July 2014 we found the provider was not meeting the regulation in relation to consent to care and treatment, care and welfare, infection control, assessment and monitoring the quality of the service and records. Following that inspection the provider sent us an action plan telling us what improvements they were going to make. During this inspection we found that the provider had made positive steps towards achieving their action plan but there were still some areas of concern relating to poor practice in the administration of medicines.
The management of medicines was not always being delivered in a safe manner. This practice on the day of our inspection was putting people at risk of not having medicines as required whilst also having access to medicine that was not intended for their use. We informed the registered manager of this practice.
On this inspection we found staff were undertaking appropriate best practice to manage infection control within the service. Previous areas relating to shortfalls had been actioned. The service at the time of our inspection had failed to undertake a current risk assessment relating to a current infection control procedure. This was sent through immediately after the inspection.
People who required support and assistance at night were receiving appropriate care and support they needed from staff. We found on the day of our inspection there were adequate staffing levels to meet people’s needs. .
Risk assessments were in place and identified where people were at risk of dehydration and malnutrition. The food and fluid charts confirmed what amounts people had consumed these had all been signed.
Care plans identified peoples mobility needs and risk assessments included details of what equipment the person required and how many staff. People and relatives told us they felt people were safe. There were policies and procedures in place which were available for staff. Training had been provided to the staff but on talking to some staff they were unable to clearly give a good account of their knowledge after receiving safeguarding training.
The service had robust recruitment and selection processes in place and we saw appropriate paperwork for all staff.
The home was undertaking when required all assessments in relation to The Mental Capacity Act and Deprivation of Liberty Safeguards. We found not all staff were able to demonstrate clearly their knowledge relating to the Act. It was also hard to establish they were competent and knowledgeable about the training they had undertaken.
The home had a variety of choices relating to meals and people we spoke with were all happy with the meals and choice within the home. We saw there were snacks available throughout the day.
We found that not all people received respectful and positive interactions from staff. People told us staff were kind and considerate but we did not always see this was the case.
Care plans related to most people’s changing needs. But one had not been updated following an incident and a change to their current need. There were a variety of activities and there was a weekly activity programme. People chose to access areas of the home as they wished throughout the day.
We found people felt aware of how to complain and confident that they could do so. We saw that were the service had received complaints that these had been responded to and actions taken.
The home was not undertaking robust quality audits that identified areas of concern in relation to building’s maintenance, health and safety and infection control. Concerns we found have since been addressed. However we require the home to have their own robust quality audits that identify shortfalls and for there to be a plan regarding completion of those shortfalls.
Staff felt well supported by the manager and that there was a open door policy. People and relatives were complimentary about the manager and deputy and said they had a good relationship with them. The service was gaining views from people who received care within Cambrian Lodge but there was only the compliments and complaints box in situ for staff and relatives to use. There was a system for recording incidents and accidents and there was a monthly analysis conducted and a log of what actions had been taken.