Cepen Lodge

Cepen Lodge is a residential care home providing accommodation and personal care to up to 63 people. The service provides support to adults over and under 65 years, people with physical disabilities and people living with dementia. At the time of our inspection there were 47 people using the service.

Accommodation is provided over 3 floors accessed by stairs and a lift. People had their own rooms with en-suite facilities. People also had access to communal areas such as lounges, dining areas and activity rooms. Access to the secure garden was from the ground floor.

People’s experience of using this service and what we found

This inspection was carried out in response to concerns raised about staffing numbers and the impact this had on people’s care. During our inspection we observed there were enough staff to meet people’s needs. However, when staffing numbers dropped to night staff levels, we observed people living in the dementia household were left with intermittent supervision at times. We have made a recommendation about this.

Improvements had been made to risk management plans and staff were reviewing them regularly or if people’s needs changed. Where people had been identified as being at risk, there was detailed guidance in place for staff to follow.

Medicines were managed safely. Staff had received training on medicines management and had their competence checked. Regular medicines audits took place which were carried out by staff and the local visiting pharmacist. Staff kept records of where they had applied topical patches and when they were changed. However, there was no record of any checks in between applications to make sure patches were still in place. We have made a recommendation about this. Staff worked in partnership with healthcare professionals to meet people’s health needs.

Health and safety checks were carried out regularly and the provider had a programme in place to make sure equipment was routinely serviced. During our inspection we observed the provider was carrying out planned refurbishment work. Risk management plans had been shared with us prior to the work starting.

People told us they were satisfied with the cleanliness of their rooms, and we observed the home was clean. Staff had access to personal protective equipment, and we observed them using it safely. Staff told us and records demonstrated training on infection prevention and control had been provided.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People and relatives told us people were safe and being cared for by staff who were kind and caring. We also observed very positive social interactions between people and staff demonstrating good relationships.

There was a registered manager in post who understood their regulatory and management responsibilities. Quality assurance and monitoring systems were in place to regularly check for quality and safety in all aspects of the service. Checks were carried out at service and provider level by various staff. Any areas for development or improvement were recorded on action plans and discussed at staff meetings. Action had been taken to make required improvements and we found the management team to be responsive to feedback shared during this inspection.

Opportunities were available for people and relatives to attend meetings at the service and share views and/or concerns. Feedback from people, relatives and staff about the registered manager and management team was positive. We were told the registered manager was approachable and listened to feedback and took action to address any concerns. Staff also had regular team meetings, supervisions and appraisals and felt able to share ideas.

Staff had been recruited safely and all told us they enjoyed their work. There were various ‘champions’ appointed amongst the staff team who took the lead in different areas. For example, there was a ‘speak up’ champion who staff were able to talk with regarding safeguarding or any other concerns. There were also dementia champions who had been given additional training to develop knowledge and skills so they could support other staff.

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 requires improvement (report published 23 February 2022).

Why we inspected

We received concerns in relation to staffing numbers and the impact on people’s care and support. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Recommendations

We have made a recommendation for the provider to include observations of practice and seek feedback from people when reviewing staffing numbers in the evening. We have also made a recommendation about medicines monitoring.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cepen Lodge is a residential care home providing accommodation and personal care for up to 63 older people. People live across three floors and the first floor is designated for people living with a diagnosis of dementia. At the time of this inspection 53 people were living at Cepen Lodge.

People’s experience of using this service and what we found

Since the last inspection the service did not have a manager for several months. During this period quality monitoring records and risk management reviews could not be located or had not been completed. We could not fully review how the service was previously monitoring the quality of the care provided and measures taken to keep people safe.

A new manager has started at the service along with a new deputy manager. Improvements had been identified by the new manager and we saw new processes were in place to address these. Under the new management team ongoing monitoring of the quality of the service and risk management reviews were being completed.

Governance systems that had been implemented needed further time to be embedded and sustained to ensure areas for improvement were identified and addressed by the new management team.

People's medicines were not always managed safely, and people were at risk of not receiving their prescribed medicines. People told us they felt safe living at the care home. Environmental risks had been assessed and managed. Staff had been recruited safely.

Improvements had been made to the culture of the service. Staff felt supported and the new manager was approachable. The manager was not known to all people and relatives but where people knew who the manager was, feedback about them was generally positive. The service worked in partnership with a range of healthcare professionals and other organisations.

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 5 May 2020).

Why we inspected

We received concerns in relation to the management of medicines, low staffing levels and people’s support plans. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Cepen Lodge on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Cepen Lodge is a residential care home providing accommodation and personal care for up to 63 older people. People live across three floors and the first floor is designated for people living with a diagnosis of dementia. At the time of this inspection 54 people were living at Cepen Lodge.

People’s experience of using this service and what we found

Medicines were not always managed safely. Concerns were identified around the recording and checking processes. We have made this a recommendation for the provider to review their systems to ensure they remain safe.

Risk assessments were in place but at times more information to record how risks were mitigated was needed. People told us they felt safe and had no concerns. Staff knew how to protect people and raise any concerns.

We saw that when people required support enough staff were available to provide this. Staff told us they felt staffing had decreased since the new provider and the impact of this was felt especially on night shifts.

Everybody we spoke with stated that they would recommend Cepen Lodge to others. People and staff told us the manager was approachable. The manager was in the process of registering with CQC.

The home appeared clean and we observed staff wearing personal protective equipment appropriately (PPE). Staff came to work in their own clothing and changed on site and then again before leaving to reduce any transmission of infection. All staff had to test prior to their working shift. The provider had adapted a room in the home to enable the management of COVID-19 testing for staff, visitors and people in the service. Staff were observed cleaning throughout the home and had access to the necessary cleaning products. Schedules showed deep cleaning of people’s rooms and high-risk areas every day to prevent the spread of infection. Gaps identified in the recording of cleaning schedules were raised to the registered manager who assured that these will be reviewed.

People told us they felt the service had done well in managing the risk of COVID-19 from spreading commenting, “It's always been very clean everywhere and they do the PPE brilliantly and wash their hands wear gloves and masks. They are very good” and “They do wash their hands and always wear gloves and masks when showering me, they are very very careful. I think they had a couple of cases of the virus at the beginning, but they’ve kept us safe all of this time.” COVID-19 care plans were in place with a friendly guide encouraging people to socially distance and wear appropriate PPE.

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 5 December 2017).

Since our last inspection the brand of this provider has changed from Brighterkind to Barchester Healthcare.

Why we inspected

This was a planned inspection based on concerns regarding an incident with catheter care.

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.

The overall rating for the service has not changed from Good. However, the safe domain has changed from good to requires improvement. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Cepen Lodge Care Home provides residential care for up to 63 older people. The first floor is designated for people with a diagnosis of dementia. At the time of the inspection there were 60 people living at the service.

This inspection was unannounced and took place on 25 and 26 October 2017.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that staff were not always signing medicine administration records (MAR) for medicines administered. MAR charts were audited daily but the audit record showed staff were not signing medicines records for medicines administered. Procedures were in place for staff that consistently failed to sign medicines records.

Procedures on the administration of when required medicine (PRN) was not in place for all PRN medicines. For example, a PRN protocol was not in place for the treatment of angina attack. We noted that for some people the instructions for the application of topical creams were not clear.

Care plans were mainly person centred and we found consistent use of terminology which showed a respectful manner. In places the information in the care plans was not cross references and not consistent with the area of need.

People said they felt safe. The staff we spoke with said they had attended safeguarding of abuse training. They knew how to identify abuse and were clear on the procedures for reporting their concerns.

Assessments tools were used to identify risk and action plans were developed on how to minimise the risk to people. The staff were clear on the actions in place to manage the identified risk. For example lowering beds for people at risk of falls. Falls audits included the preventative measures and lesson learnt from the event. We saw from the audit the number of falls had reduced from the preventative actions taken.

Intervention charts in place followed risk assessments and were well completed. 24 hour fluid charts detailed people’s individual fluid intake target and were totalled throughout the day. Where people did not have enough to drink the information was passed to staff during handovers. A member of staff said the introduction of the monitoring fluids had improved people’s health.

Incident and accidents reports were completed. An online incident reporting system was used by staff to record accidents and incidents. The reports were investigated at provider level for patterns and trends and the registered managers received feedback on the analysis of accidents.

The number of staff on duty reflected the duty rota. We saw staff available at all times. Staff took their time with people and care was not observed to be rushed. However, staff said there was staff sickness. Action was being taken by the registered manager to manage sickness and absences.

Staff told us the training was good. There was mandatory training set by the provider which staff said they had attended. There were opportunities for vocational qualifications. Staff said during their one to one supervisions they discussed concerns, the people at the service and performance.

Staff knew the day to day decisions people were able to make. People’s capacity to make decisions about their care and treatment was assessed with accompanying best interest decisions in place for specific decisions.

The people at the service had support with their healthcare needs. People were registered with a GP and had access to other specialist’s healthcare professionals such as district nurses and Speech and Language Therapists (SaLT).

The dietary requirements of people were being met and people said they enjoyed the food.

Staff greeted people by name and knocked on bedroom doors before entering. They close bedroom doors before delivering personal care. Staff knew people well, interactions were not rushed and they knew how to reassure people when they became distressed.

The complaints procedure was kept in a welcome pack in people’s bedrooms. Complaints received were investigated and resolved to a satisfactory level.

Staff said since the last inspection there had been improvements. They said they worked well together and there was good team spirit. All staff spoke well about the registered manager and said they were approachable.

Formal systems were in place for assessing, monitoring and to mitigate risks relating to the health, safety and welfare of people who used the service. There were clear processes that ensured the delivery of care met good practice guidelines, legislation and the values of the organisation as well as those of the home. Where shortfalls were identified action plans including medicine errors were in place on how outcomes were to be met.

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Cepen Lodge provides residential care for up to 63 older people. The first floor is designated for people living with a diagnosis of dementia.

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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risks were assessed and action plans developed on minimising risks. A Malnutrition Universal Screening Tool (MUST) was used to assess people’s potential risk of developing malnutrition. However the action plans developed as a result of the MUST were not consistently followed by staff to support people with poor nutrition. Charts used to monitor fluid intake were not consistently completed. This meant fluid intake charts did not provide staff with an audit trail of people’s deterioration. The registered manager told us through the Provider Information Return (PIR) this was to be addressed.

Risks were assessed for people with poor mobility and at risk of falls. Moving and handling risk assessments were developed which gave staff guidance on the number of staff and the equipment needed for each manoeuvre. Waterlow assessments were undertaken to assess people’s risk of pressure ulcers and action plans included the equipment used to prevent skin damage. Repositioning charts were used to monitor that people were moved regularly and were not exposed to prolonged pressure on the same body area.

Although the premises were clean we noted strong odours at times and in different places within the home. The registered manager said there had been housekeeping staff vacancies which were now filled and staff were to start working at the home once their induction was complete. We were also told new equipment was to be purchased and some remedial action to the property was to take place.

Care plans were not consistently person centred. People’s likes and dislikes and preferred routines were not always included within the care plans. People’s life history was not always documented. Care plans were reviewed but they were not always updated where there were changes in people’s needs.

People told us they liked living at the home and they felt safe. The staff were knowledgeable about the safeguarding of vulnerable adults from abuse procedures. The staff were able to list the types of abuse and the expected action for alleged abuse.

Medicine systems had improved since the last inspection and were effective. Staff said medicine errors and where there were omission of signatures on medicine administration records (MAR), were rare. Staff signed MAR charts to indicate when medicines had been administered. Protocols were developed for the administration of “when required” (PRN) medicines.

People and relatives said overall there was enough staff on duty but at lunchtimes more staff was needed to support people with their meals. The registered manager said activities coordinators were available to assist people with their meals.

Staff attended training which increased their skills and insight into people’s needs. Mandatory training set by the provider was attended by the staff. Staff said there were opportunities for vocational qualifications. Appraisals were annual and as a result of the discussions on areas of special interest, lead roles were assigned. For example, staff were assigned to take the lead on nutrition. One to one meetings took place to discuss performance but not to discuss personal development.

People were able to tell us the decisions they were able to make. Members of staff were knowledgeable about the principles of the Mental Capacity Act (MCA). MCA assessments were in place for specific decisions. Records were clear where Lasting Power of Attorney were appointed. Deprivation of Liberty Safeguards (DoLS) applications were made to the supervisory body for people under continuous supervision.

People told us the staff were caring and respected their rights. Members of staff knew it was important to build trust to people and to show them they mattered. We saw good interaction between people and staff. Relatives told us the staff were good and cared for their family member.

The views of people were gathered. Relatives meetings were held regularly with the registered manager and deputy manager.

Staff said the registered manager was approachable. They said the expectations were high but they were appreciated for the work they did.

Quality assurance systems were in place which included internal audits. Where there were shortfalls action plans were developed on how improvements were to be made to meet set standards and the necessary action was taken to implement change.

You can see what action we told the provider to take at the back of the full version of the report

We met with several staff during our inspection, including the chef, activity coordinators and care staff. One of them said that they felt morale in the home had improved and that staff 'want to come to work'. They put this down to the temporary manager who they said had 'made a real difference'.

People's needs were assessed and care was delivered in line with their agreed plan. People were offered a range of opportunities both inside the home and when going out. The meal provided had improved and was served in pleasant surroundings. There were opportunities for people to give feedback on the menu. Records relating to the care and welfare of people who lived in the home had improved and those we looked at reflected the support people required.

Since our last visit there had been improvements in the administration of medicines. A new pharmacist had introduced a new system for administering medicines and staff training had been provided.

From speaking with deputy manager, examining records and speaking with care staff it was clear that there had been a medication error. On Tuesday 25 June 2013 at 9 PM all of the people on the second floor of the home had not received their prescribed medication. This error had not been identified by the management team as medication administration had not been audited.

We spent all day at the home and were present on all three floors throughout this time speaking with people living in the home, relatives and staff.

Comments from people and relatives included; "My mother was involved in my Nan's care plan at admission and is consulted with on an on-going basis', 'A very nice room, I have no complaints' and, 'They are very good (the staff), they bring me my meals here', "'They (the staff) wouldn't enter (my relatives) room without knocking on the door, they are dedicated and wonderful', 'The carers do really care, they always tell me when there is a problem', 'I feel very comfortable here, the staff are polite and friendly'.

Observations throughout the day showed that people were treated with respect and dignity by the staff.

Observations, looking at care documents and talking with people raised concerns about staff meeting all the needs of people in the home.

We spoke with five members of the care staff who were on duty. They told us they were well supported by the management team and received the necessary training and information they needed for their roles. Staff said they felt they knew people well, their likes and dislikes and were familiar with their care plans.

People told us they knew how to make a complaint and if they were unhappy about any aspect of the service they would speak with care staff or the manager.

In this report the name of a registered manager appears who was not in post and not managing the regulatory 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.