Archived: Shakti Lodge

Updated 22 February 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 17 and 20 January 2017. The first day of the inspection was unannounced and the second day was announced. The inspection team consisted of one inspector.

Before the inspection, we looked at previous inspection reports and notifications about important events that had taken place in the home, which the manager is required to tell us by law. We also looked at information we had received from the public and the local authority. We used all this information to decide which areas to focus on during our inspection.

We spoke with four people and two relatives at the time of the visit. We spoke with a third relative on the telephone following the inspection. We spoke with the area manager, the acting manager and eight staff. These included two senior carers, two carers, the activities co-ordinator, the cook, the domestic cleaner and the laundry person. We asked for feedback from three health and social care professionals involved in the commissioning of the service.

Most people who were living with dementia were not able to verbally communicate their views with us or answer our direct questions. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We observed staff interactions with people and observed care and support in communal areas.

We looked at records kept by the home these included three people's records, which included care assessments and plans, risk assessments and daily records. We looked at records that included staff records, a sample of audits, meeting minutes, policies and procedures. We also looked around the care home and the outside spaces available to people.

Updated 22 February 2017

The inspection was carried out over two days on 17 and 20 January 2017. On 17 January the inspection was unannounced. We returned to complete the inspection on the 20 January 2017, this visit was announced.

Shakti Lodge provides accommodation for up to 26 people who need accommodation with personal care. However, the home currently does have rooms that are for two people which are being used as single rooms. This therefore means the total occupancy level available at present is 21. The acting manager told us that they would only use the double rooms for a married couple if requested. Communal areas, such as the lounge and dining room are on the ground floor with a few bedrooms. Bedrooms are mainly found on the first floor and are accessed by stairs and/or a passenger lift. There was a garden to the rear of the building which had been developed as an accessible space for people to use during the better weather. At the time of our visit, 16 people lived in the home. People had a variety of complex needs including dementia, physical health needs and mobility difficulties.

At the previous inspection on 16 and 17 May 2016, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to ensuring that people received appropriate person centred care that met their needs and reflected their preferences; failure to monitor the risk to people who may present with malnutrition; failure to reduce the risk of cross infection; ensuring that medicines were managed properly; and not operating effective auditing systems. The provider sent us an action plan telling us what steps they would be taking to remedy the breaches in Regulations we had identified. At this inspection we checked they had implemented the changes.

At the previous inspection on 16 and 17 May 2016, we also made four recommendations to assist the provider to make improvements to the service provided. These recommendations were in relation to seeking advice on how to keep people safe while awaiting further employment information; putting a system in place to monitor and ensure that people eat and drink enough through the day, to maintain their health and wellbeing; training staff about how to communicate with people in a way that protects their dignity, shows respect, and to put a system in place that makes sure that people’s interests and hobbies inform the activity plan either in group activities and one to one time.

At this inspection we found improvements had been made.

There was no registered manager employed at the service as the registered manager had recently resigned. 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 deputy manager had stepped up and was currently the acting manager. Following the inspection we were informed that the acting manager had been successful at interview and would be applying to the commission to be the registered manager.

The staff knew their responsibility regarding reporting any safeguarding issues and made sure that safeguarding alerts were raised with other agencies. All of the people who were able to speak with us said that they felt safe in the home; and said that if they had any concerns they were confident these would be quickly addressed by the acting manager.

The home had risk assessments in place to identify risks that may be involved when meeting people's needs. These risk assessments showed ways that these risks could be reduced.

Medicines had been administered following the provider's medicines policy and following good practice guidance. Medicines records were accurate and complete. There were no 'homely remedies' held in stock. We made a recommendation about this.

Staff were recruited safely and had been through a selection process that ensured they were fit to work with people who needed safeguarding. Recruitment policies were in place that had been followed. Safe recruitment practices included background and criminal records checks and now also included a record of explanation for any gaps in employment, prior to staff starting work.

Staff were receiving supervision which had been planned to make sure staff received support on a regular basis.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The area manager and acting manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded. The acting manager knew to let CQC know about other events such as safeguarding concerns and deaths. There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA), which included steps that staff should take to comply with legal requirements. Staff had a good understanding of the MCA 2005 to enable them to protect people's rights.

Food surveys had recently been completed in order for the menus to reflect people’s food preferences. The menus offered variety and choice. They provided people with nutritious and a well-balanced diet. The cook prepared meals to meet people's specialist dietary needs. We found staff recorded some of what people ate and drunk in the daily notes.

Staff supported people with health care appointments and visits from health care professionals. The staff recorded the outcome of these visits. Care plans were being amended to show any changes and staff spoken with knew what care and support people were having.

We saw that there were activities planned during the week by the activity co-ordinator and staff. Regular entertainment was also provided by people coming in to the home for example exercises to music.

People were treated with kindness. Staff were patient and encouraged people to do what they could for themselves, whilst allowing people time for the support they needed. Staff encouraged people to make their own choices and promoted their independence.

Complaints were managed in accordance with the provider's complaints policy a copy of the procedure was displayed in entrance to the home.

People's needs were fully assessed with them before they moved to the service to make sure that the service could meet their needs.

People spoke positively about the management team and staff. Staff understood their respective roles and responsibilities. Staff told us that the acting manager was very approachable and understanding.

There were systems in place to enable the acting manager to assess, monitor and improve the

quality and safety of the service. The area manager was supporting the acting manager and carrying out regular audits to check how the home was run and the views of the people and staff.t