Archived: Cary Lodge

Updated 17 May 2019

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. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

The inspection team consisted of two adult social care inspectors, one assistant inspector, one inspection manager and one 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. In this case, the area of expertise was older people and dementia care.

Service and service type:

This is a residential care home that provides accommodation and personal care to people.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

This inspection was unannounced.

What we did:

Before the inspection we reviewed information we held regarding the service, we looked at notifications we received since the last inspection. Notifications are when the service tells us of an important event. We also reviewed recent safeguarding records and spoke with the local authority quality improvement team who had been supporting the service.

During the inspection process we spoke with six people living in the service. Nine staff members including the registered manager, deputy manager, staff training lead and cook gave us feedback. We also spoke with seven relatives during the inspection process and received feedback from three health professionals.

We looked at care records for seven people, this included risk assessments and needs assessments and daily recording of care provided. We looked at consent documents, falls records, four staff files for supervision and recruitment and training. We also looked at Medicine Administration Records (MAR) and how medicines were received, stored, administered and disposed of.

We spent time in the communal lounge throughout the day observing how staff interacted with people and also conducted an informal observation of breakfast and a SOFI during the lunch time meal. SOFI, or short observational tool for inspection is a way of observing care provided to people who may struggle to communicate their experiences to us.

We walked around the home and saw the kitchen and all communal areas and bathrooms. We saw the bedrooms of six people living in the home and checked the upstairs windows in communal areas for fire and safety reasons.

Updated 17 May 2019

About the service: Cary Lodge is a residential care home in the coastal town of Torquay that is registered to provide accommodation with personal care for up to 40 people over 65 years of age. At the time of our inspection there were 13 people living there. The home is set over three floors but only two were being used by people living in the home.

People’s experience of using this service:

• People were put at risk of receiving care and treatment that was unsafe. Risks relating to health concerns and behaviours that challenged were not fully assessed. The service had not taken action to reasonably mitigate these risks. Some risks had not been escalated to health care professionals for advice.

• Infection control practises needed improving and the laundry was disorganised which heightened the risk of cross contamination. People’s clothes sometimes went missing or were worn by other people.

• Medicines were not always well managed, or administered at the correct times. Staff had not all received training in how to support a person that needed oxygen to help them to breathe.

• There were not enough staff in key communal areas to ensure people were safe and to meet their social needs.

• Activity provision was poor. People told us they felt bored. We saw some interactions between staff and people that were not respectful or dignified. Other interactions were caring and kind.

• Oversight of the running of the service was inadequate. Quality control had not picked up on some of the issues we found on this inspection and some issues were repeated from our last inspection.

• However, we did see some improvements. Consent documents had been more thoroughly completed, and the service had made efforts to improve care planning.

• Understanding of safeguarding people had improved and recording of falls was more detailed and showed a level of analysis the service could learn from to prevent reoccurrence.

Rating at last inspection:

At our last inspection on 12 and 18 June 2018 we rated the service Inadequate. The report was published on 10 September 2018.

Why we inspected:

This was a scheduled inspection based on the previous rating. When a service is rated Inadequate it is inspected again within six months to see if improvements have been made.

Enforcement:

Enforcement action will be published at the end of this report once the provider has had adequate time according to our enforcement process to respond to our proposals.

Follow up:

The overall rating for this service is Inadequate. This means that it remains in special measures.

The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded. We will have contact with the provider and registered manager following this report being published to discuss how they will make changes to ensure the service improves their rating to at least Good.