White Lodge Care Home

Updated 24 April 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors, an assistant inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

White Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided. A manager had been recently appointed who would be applying for registration, we have therefore referred to them as ‘the manager’ throughout the report.

Notice of inspection

We gave the service 30 minutes notice of the inspection visit as we needed to be sure the inspection could be undertaken safely.

What we did before the inspection

We reviewed information we had received about the service since the last inspection including notifications. Notifications are information about specific important events the service is legally required to send to us. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We received feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection.

During the inspection

We spoke with four members of staff, including the manager, housekeeper, activity staff member and a care assistant. We spoke to two service users and we spent time observing the support and interactions between people and staff. We also reviewed the environment and a range of records. This included three staff recruitment records, four care plans and multiple medication records.

After the inspection

We spoke with a further five care staff members by phone. We spoke with three people by phone and seven relatives. We continued to review care records in total for five people. A variety of records relating to the management of the service, including policies and procedures were reviewed. We continued to seek clarification to validate evidence found.

Updated 24 April 2021

About the service

White lodge Care Home is a residential care home providing personal care and accommodation to up to 25 people, including people living with dementia. At the time of the inspection they were supporting 20 people. Accommodation is arranged over two floors in single bedrooms. There are two communal lounges, a dining room and access to a garden and patio area.

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

Risks to people using the service had not always been assessed. Plans were not always in place to mitigate these risks. There was a lack of guidance and information for staff about some risks which meant people were at risk of receiving inappropriate or unsafe care and treatment.

We received mixed feedback about the staffing levels in the home. The provider did not have a robust or effective system in place to determine the number of staff required to meet people’s needs. Suitably trained and competent staff were not always available on-site to administer people’s medication. Not all the required checks had been completed as required to help ensure people were protected from the employment of unsuitable staff.

External medicines were not always administered as prescribed, the operations manager told us they would investigate this. The effectiveness of a person’s medication with a variable dose was not monitored to mitigate risks to the person from their condition. We have made a recommendation about the management of these medicines.

The system in place to identify, asses and mitigate risks to people from the quality and safety of the service was not always effective. We received mixed feedback from staff about the culture in the service. Staff views had not been formally sought and analysed over the past year.

People’s relatives told us their relatives were safely cared for in the home and they had regular communication about their relative from staff. Restrictions on visiting meant relatives had not been able to have in person contact regularly inside the home over the past year. People we spoke with who were able to tell us about their care told us they felt safe and well-cared for in the home.

Rating at last inspection

The last rating for this service was Good (published 03 March 2020).

Why we inspected

We received concerns in relation to the management of medicines, staffing levels, people’s needs in relations to falls and moving and handling, leadership and culture. 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 report. You can see what action we have asked the provider to take at the end of this full report.

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.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified breaches in relation to safe care and treatment, staffing fit and proper person employed and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.