Archived: Shakti Lodge

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

This inspection took place on 16 and 17 May 2016 and was unannounced.

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 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, 20 people lived in the home. People had a variety of complex needs including dementia, physical health needs and mobility difficulties.

There was a registered manager at the home. 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 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 converse 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 registered manager.

The home had some 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. However not all risks had been identified and therefore staff were not always putting in measures to keep people safe or reduce those risks.

Medicines had not been administered following the provider’s medicines policy and following good practice guidance. Medicines records were not accurate or complete.

The recruitment procedures were not robust in all cases. We have made a recommendation about this.

Training records showed that staff had completed training in a range of areas that reflected their job role. They 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 homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority and had been approved. The registered manager knew that CQC needs to be notified when Deprivation of Liberty Safeguards (DoLS) applications that had been agreed. The Registered manager had 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.

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. We found that some people who needed close monitoring of their food and fluid did not have charts to record this effectively. We have made a recommendation about this .

Staff supported people with health care appointments and visits from health care professionals. The staff recorded the outcome of these visits. Care plans were not always amended immediately to show any changes. However staff spoken with knew what care and support people were having. We have made a recommendation about this.

We saw that there were activities planned during the week by the activity co-ordinator and regular entertainment was also provided by people coming in to the home for example they had exercises to music, and a singer who visited.

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 home to make sure that the home 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 registered manager was very approachable and understanding.

There were a lack of systems in place to enable the registered manager to assess, monitor and improve the quality and safety of the service. Audits undertaken had not picked up the concerns for example around the administration of medicines and care plans records. The area manager who was responsible for monthly audits to check how the home was run and the views of the people and staff had not taken place since October 2015.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found

Is the service caring?

The atmosphere at the service was calm and friendly. People we spoke with told us that the staff knew how to meet their needs. One person told us “Of course they do” when they were asked if the staff knew how to care for them. They added that they had “No complaints”. Another person told us that the staff knew how to look after them well and that the staff “Try their best”. This meant that people received care from staff who were skilled in meeting their needs.

Is the service responsive?

We saw a record that showed one person’s medication had changed and the senior staff member we spoke with who was administering medication had been informed about this change.

We saw records that showed the number of staff on duty had increased earlier this year in response to a change in one person’s needs.

Is the service safe?

There was a system in place to ensure staff received the necessary training to undertake their role safely. There was a system in place to ensure that staff were competent in administering medication to people who lived at the service. Staff undertook checks ensuring they were of good character and that they were entitled to work in the UK.

Is the service effective?

There was a process for deciding how many staff should be on duty to meet people’s needs. We saw that the amount of staff on duty reflected the amount of staff required. This was also reflected in a recent staff rota. There was a robust recruitment process that followed legal requirements.

Is the service well led?

One staff member we spoke with told us that they could talk to the manager if they considered that additional staff were required to meet people’s needs. They were confident that this would be responded to appropriately by the manager. Three members of staff confirmed they felt supported by the manager to carry out their roles and were able to discuss any concerns.

Below is a summary of what we found

Is the service safe?

Risk assessments had been completed to ensure people’s safety while promoting their independence. Staff were supported to undertake their role safely and effectively. There were systems in place to monitor health and safety within the service. Records showed that regular checks related to fire safety were carried out at the service.

Is the service effective?

At this inspection we saw that people’s care plans were person centred. They now contained information about their likes and dislikes and information about their personal history for staff to be able to know more about the person they supported. People were supported in promoting their independence. One person’s care plan showed what aspects of their personal care they were able to do themselves. People and their relatives were involved in the planning of their care.

Is the service caring?

People we spoke with told us that the staff at the service were caring, one person told us that the staff knew how to support them. Comments included “The staff are very good”, “The carers are good, they look after me well, they are easy to talk to,” and “The staff are alright”. When discussing the service the relative told us “I think it is excellent. The staff are really caring and friendly and always have time for my [relative].” They told us that the staff spend time talking with their relative. During the inspection we saw that staff spent time talking with people and both staff and people were laughing during these conversations. The atmosphere was friendly and relaxed.

We saw that staff took the time to provide care to people safely and carefully. For example a staff member carefully ensured a person was safely seated before they ate their meal and went at the person’s pace when providing this support.

Is the service responsive?

We saw that people’s needs were assessed before they moved into the service and ongoing needs were monitored and reviewed to ensure their welfare. Guidance was sought from health professionals when needed in response to changes in people’s needs and the monitoring of people’s needs. Records showed that one person had suffered from a health matter and the action taken in response to this that included a course of medication. There was evidence that learning from incidents and investigations took place and appropriate changes were implemented.

Is the service well led?

There were systems in place to monitor the quality of service delivery. These included providing a survey for relatives to gather feedback about the service and a complaints process. There were systems in place to monitor staff training and competency that showed staff received training relevant to their role.

We found people did not experience care, treatment and support that met their needs and protected their rights. We spoke to people who used the service and relatives who told us they were not involved in the care planning process.

We found that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

We found the provider did not have effective system to regularly assess and monitor the quality of service that people receive.

We found that the provider did not have an effective complaints system available. Comments and complaints people made were responded to appropriately.

People we spoke to told us they liked living at the home. Comments included “I like living here” and “I am happy here” and “The staff are lovely, I like them”.

People spoke about the activities they liked doing and said that there was a good choice of activities on offer.

People we spoke with said that they were happy living in the home and that they enjoyed activities such as ‘bingo’. Comments included “I am looked after here”.

People we spoke to told us that they liked the meals provided, comments included “I enjoy the food” and “the meals are always nice”.

We spoke with people using the services but their feedback did not relate to this standard.

Staff we spoke to told us that they could speak to the manager at any time if they were unhappy about anything at the home.

Staff we spoke to said that they enjoyed working at the home and received the training and support they needed to do their jobs. Comments included “We all work as a team” and “I can go and speak to the manager at any time”.