Archived: Ocean Hill Lodge Residential Care Home

Ocean Hill Lodge is a residential care home providing personal care to 15 people aged 65 and over at the time of the inspection. The service can support up to 18 people. The service is based in a detached two-story property with a front patio garden that people can access.

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

Staff and the registered manager had a good understanding of local safeguarding procedures. Appropriate guidance and advice had been sought from professionals in relation to a specific concern and appropriate measures taken to ensure people’s safety.

Staff had been provided with guidance on the management of risks within the service and understood how to meet people’s pressure area care needs. Accidents had been investigated to identify areas of improvement or learning and to prevent similar incidents from reoccurring.

The service’s recruitment practices were safe and there were sufficient numbers of staff available to meet people’s care needs. People told us, “If you need them, they come quickly, they are very quick” and a relative said, “The carers, they are amazing”.

Staff were using PPE correctly and following current infection prevention and control guidance to help keep people safe. All staff had been provided with additional training in relation to the Covid-19 pandemic and arrangements made to enable relatives to safely visit.

The registered manager provided effective leadership. Staff told us they had been well supported and reported the registered manager had made significant improvements within the service.

The service’s quality assurance systems were effective and action had been taken to address and resolve the breach of the regulations identified at our last inspection.

Feedback from people and their relatives about the service’s performance was valued by the registered manger and any issues raised had been investigated and resolved. The duty of candour was understood by the registered manager and relatives told us the service communicated with them effectively.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 17 July 2019) and there was a breach of the regulations.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 02 July 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to help ensure service users were protected from the risk of abuse and improper treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements.

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 COVID-19 and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires improvement to Good. This is based on the findings at this inspection.

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

Ocean Hill Lodge is a residential care home which was providing personal care to 17 people on the day of the inspection. The service can support up to 18 people. Accommodation is spread across two floors.

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

Action to report safeguarding concerns were not made in a timely manner. This meant it could have been difficult for external agencies to complete investigations.

Records were not always in place to clearly indicate how often people should be receiving care and support. Although there was no indication anyone had sustained harm as a result, this failure put people at increased risk. The registered manager took immediate action to address this shortcoming.

The ethos of the service was to provide an environment that was welcoming and homely. Staff were identifiable by their clothing but this was not a traditional uniform. Seating was arranged in small groups and people sat together chatting, watching TV and completing puzzles. Staff stopped to talk to people frequently and the atmosphere was relaxed and friendly. A member of staff told us; “It’s not ‘them and us’, it’s just ‘us’.”

People were supported to maintain their independence. Some people chose to self administer medicines and this was supported. Some people had bus passes and frequently went out to use local facilities and keep up their interests.

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.

The registered manager was known by people and staff and was highly visible. People came into the office to chat and this was clearly something they were used to doing. Staff told us they were well supported and able to raise any concerns or suggestions. The registered manager responded immediately to any issues identified during the inspection.

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 (report published 5 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach of regulations in relation to the failure to raise a safeguarding in a timely manner. Please see the action we have told the provider to take at the end of this 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.

Ocean Hill Lodge is a care home which offers care and support for up to 18 predominantly older people. At the time of the inspection there were 16 people living at the service. Some of these people were living with dementia.

The registered manager is one of the providers and has worked in this role for many years. 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. However, a new manager had recently been appointed by the owners in addition to the registered manager and had been in post since October 2016. The registered manager was not present at the time of this inspection.

We walked around the service which was comfortable and personalised to reflect people’s individual tastes. There were some incontinence odours experienced by the inspectors on the ground floor of the service. Some people had requested that their bedroom doors were open at all times. The doors were held open by devices that were connected to the fire alarm system. This meant that the device would automatically close in the event of a fire. However, the level of the carpet in some people’s rooms was below that which enabled the door device to work correctly. Carpet pieces and tape had been used to raise up the carpet level to address this issue which led to a potential trip hazard. The service was working with the maintenance person to address this issue.

People were treated with kindness, compassion and respect. There were sufficient numbers of staff to meet people’s needs.

We looked at how medicines were managed and administered. We found people received their medicines as prescribed. Regular medicines audits were consistently identifying if any errors occurred. These were taken up with the identified member of staff and addressed.

Staff were supported by a system of induction training, supervision and appraisals. Staff knew how to recognise and report the signs of abuse. Staff received training relevant for their role and there were opportunities for on-going training and support and development. Some more specialised training specific to the needs of people using the service had been completed by a few staff. The manager told us that further dementia training was planned for all the care staff.

Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Care plans were held on a computer. Paper copies of people’s care plans were also kept for families to view. The computer held care plans and the paper copies and contained detailed information about people’s social and care needs. However, some information held on the computer was not evident on the relevant care plan section. For example, falls recorded on the system were not showing on the falls care plan risk assessment. This was addressed with the IT company at the time of the inspection. This meant that some care plans were not entirely accurate and did not always contain up to date information. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate, relatives were included in the reviews.

Accidents and incidents were recorded at the service. Such events were held on the computer system in each person’s care records. However, the manager was not yet able to pull this information together in one place easily. This meant that the management team did not have an overview of all accidents and incidents and therefore were not easily aware of any patterns or trends to help to reduce future incidents. The computer system support team was helping the staff to learn how to do this.

Activities were provided at the service. A programme of activities was in place. People were seen going out to the local area independently. Others were supported to go for coffee and sit by the sea. People were encouraged to help with domestic tasks around their home such as setting tables for lunch and folding laundry.

The registered manager was supported by a new manager and a deputy manager. There were a number of staff who had worked at the service for many years. Staff were happy working at Ocean Hill Lodge and told us morale was good.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches. We undertook a focused inspection on the 18 March 2016 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to the topics as outlined above. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Ocean Hill Lodge’ on our website at www.cqc.org.uk’

Ocean Hill Lodge Residential Care Home provides accommodation for up to 18 people who require care and support. The service mainly provides support for older people and people living with dementia. There were 15 people living at the service at the time of our inspection.

The registered manager is one of the providers and has worked in this role for many years. 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 and associated Regulations about how the service is run.

At our focused inspection on the 18 March 2016, we found that the provider had followed their plan which they had told us would be completed by February 2016 and the legal requirements had been met.

Care plans contained risk assessments which identified when people were at risk, for example from falls. Guidance for staff was contained in care plans and provided detailed information on the action staff should take to minimise the risk.

People told us they considered Ocean Hill Lodge to be a safe environment and that staff were skilled and competent. People, relatives, staff and professionals spoke of the service as having a ‘family’ feel. Terms such as ‘homely’ and ‘friendly’ were frequently used. There was a relaxed and friendly atmosphere in the service. People chatted and joked together and with staff.

Medicines management had been risk assessed and certain processes changed to improve the system. For example, staff now wore red tabards to make people aware that they were administering medicines. Medicine audits and appropriate daily checks were now taking place. This meant the management were now more aware of areas where issues could occur and took action promptly to deal with them.

Staff understood how to keep people safe and the processes to follow if they wanted to report a safeguarding concern to the local authority. There were emergency evacuation plans in place to ensure people could be safely evacuated in the event of an emergency. Fire safety systems were in place and were regularly monitored. For example by regular testing of the fire evacuation system.

Management made inspectors aware that the service was seeking to recruit new care staff. There were sufficient numbers of staff to meet people’s needs, however, at times agency staff were being used to fill staffing requirements. The registered manager was aware people’s needs were increasing and was recruiting additional care workers for both day and night shifts as a result. The new employees would also be able to cover for any staff absence.

Pre-employment checks such as disclosure and barring service (DBS) checks and references were carried out. New employees undertook an induction before starting work to help ensure they had the relevant knowledge and skills to care for people. Training was regularly refreshed so staff had access to the most up to date information. There was a range of training available to help ensure staff were able to meet people’s needs. Accidents and incidents were recorded and appropriately investigated by management.

The registered manager had oversight of the service and people, relatives and staff told us they were available and approachable. They were supported by a management consultant, a deputy manager and an administrative worker who also worked shifts delivering care. In addition, there were kitchen staff, cleaning staff and a maintenance worker. The providers were in the process of recruiting a service manager to enable the current registered manager/provider to move towards retirement.

Robust quality assurance processes were in place. These were regularly reviewed to help ensure the management of the service could identify any trends or patterns that would need addressing to improve the service provided to people.

In September 2014, the Care Quality Commission received information of concern relating to how Ocean Hill Lodge was operating. In response to this we conducted a two day inspection to address the issues of concern.

During the inspection we were able to speak with seven people who used the service. We also spoke with the provider, deputy care manager and six care staff who worked at the home.

Below is a summary of what we found.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

On the day of inspection, we judged the service was unsafe for the people who lived at Ocean Hill Lodge. This was because staff were unclear about multi-disciplinary safeguarding procedures. The provider had not referred a number of safeguarding issues appropriately.

Is the service effective?

On the day of inspection we judged the service was ineffective. This was because some people told us they were not supported with their personal care in a timely manner. One person remarked, 'I've had to wait for nearly half an hour to go to the toilet after I've called staff'. We also saw one person had a call bell that was not working. This meant the person could not alert staff to their needs without using a pressure mat on the floor.

Care records, were up to date and accurately recorded the current situation for each person who lived at the home. There were risk assessments in place to identify risks. However, we found there was insufficient detail within the risk assessments about what action was required in the event of a person suffering an incident .

Is the service caring?

On the day of inspection we concluded the service was caring. We found there was a mixed response from people about the care they received at the home. Some people told us they were 'happy' living at Ocean Hill Lodge. Others remarked that staff were 'too rushed' and they had to wait for prolonged periods before being assisted with their personal care.

The interactions we saw between staff and people demonstrated that people were treated with respect and care. We saw a number of positive interactions throughout the two days of inspection. We saw staff mainly interacted with people when they were attending/supporting them with personal care or when serving food at meal times. We did not see staff members spending time sitting and talking with people.

Is the service responsive?

We found a number of instances where the service had not appropriately referred safeguarding matters to the Local Authority. Lack of multi-disciplinary working in this area had led to instances of continued behaviours by one person which was not in the best interests of other people who lived at the home.

The home worked in conjunction with other professionals such as the District Nursing team to ensure appropriate care was provided.

Is the service well led?

Based on the evidence we looked at and the responses from people we spoke with, we concluded that at the time of inspection the service was not well led. This was because processes to ensure the quality of the home, such as training, were not effective.

The provider was unclear about their responsibility to protect people by liaison with the Local Authority. We saw examples of the provider assuming responsibility to deal with an issue themselves rather than involve other agencies appropriately. This detrimentally affected people at the home.

Staff training in a number of areas was not current and there was a lack of co-ordinated management response to handling this.

We saw that staff showed, through their actions, conversations and during discussions with us a good understanding of people's care needs and were friendly, warm and compassionate to those they cared for.

We reviewed the systems for managing medication in the home and found this took place in a safe and appropriate way.

The records held by the home demonstrated a robust and effective recruitment procedure was carried out when appointing new staff.

We reviewed a number of records which staff maintained regarding the care of people who used the service and found these were up to date and stored securely. We also reviewed a number of staff personnel files and found these had been developed since our last inspection and were now ordered, up to date and stored securely.

People who used the service told us activities were available for them to join in with if they chose.

We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We had concerns regarding the administration of medication in the home. We saw that the staff were not acting in accordance with the written policy and procedure and this meant the risk of error was increased.

There was insufficient evidence in place to demonstrate that a robust and effective recruitment procedure was carried out when appointing new staff.

Staff were provided with support, supervision and training and since our last inspection, the training programme had been developed and updated.

Records were not consistently maintained and were not always reflective of the most up to date information regarding people's care needs.

We spoke with two people who were visiting their relatives in the home. They both told us they were satisfied with the care their relative received.

We were also able to speak with an external professional who was visiting a person who used the service. They told us the home liaised well with them to ensure people received appropriate health care.

The home was homely and furnished in a domestic style. We saw the home appeared clean and was free from odours on the day of our inspection.

Care documentation was not up to date and did not provide staff with sufficient detail regarding people's care needs.

The medication procedures did not ensure the safe keeping of people's medicines at all times.

Recruitment procedures were not sufficiently robust to protect the people who used the service from receiving their care from staff not suitable to work with vulnerable adults.

Staff did not receive regular supervision or training to ensure they were competent to deliver care to people.

Three people told us that they felt at home at Ocean Hill Lodge and one person said "It is great here, I have been in other homes but this is like one big family and the staff are just marvellous". Another person told us "we are all one big family and I like that".

We spoke with two people who were visiting their relatives in the home. One person told us that they were very pleased with the excellent care provided to their relative. Another visitor told us "we are completely satisfied with the home and we have peace of mind to know that XXXX was looked after so well".

The people we spoke with all said that they enjoyed the food they received. We were told that the food was varied and home cooked. The people we spoke with were all clear that if they did not like the menu choice they were able to ask for something different.

The home had a warm and welcoming atmosphere during our inspection visit. We saw that the furnishings and d'cor were domestic in style and provided a homely and comfortable environment.