Archived: Atherton Lodge

Updated 30 June 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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.

We visited the service on 5 and 7 July 2017 and our inspection was unannounced on the first day. The inspection team on the first day consisted of two adult social care inspectors and one adult social care inspector on the second day.

We spoke with seven people who used the service and two family members visiting the service. We spoke with the manager and six members of staff who held various roles including care staff, the chef and domestic staff. We looked at the care records relating to seven people who used the service, which included, care plans, daily records and medication administration records. We observed interactions between people who received support and staff.

Prior to the inspection we reviewed the information we held about the service including notifications of incidents that the registered provider sent us since the last inspection, such as complaints and safeguarding information.

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 care and support in communal areas and staff interaction with people during a mealtime.

Updated 30 June 2018

We carried out an inspection on 5 and 7 July 2017. The first day was unannounced.

Atherton Lodge is a privately owned two-storey detached property that has been converted and extended into a care home. It is registered with Care Quality Commission (CQC) to provide accommodation for up to 40 older people who require personal and nursing care. Some people at the service were living with dementia. At the time of the inspection there were 17 people living at the service who required accommodation and personal care only.

There was no registered manager in place. 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. There was a manager in post who had been interviewed by CQC for registration at the service.

At the last comprehensive inspection on the 12 and 13 December 2016 we identified breaches of Regulations 11, 12, 15 and 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 and found that a number of improvements were required at the service. People were not protected from the risk of unsafe care and treatment and the systems and processes which the registered provider had in place to assess, monitor and improve the quality and safety of care were not effective. Consent to care and treatment was not always sought in line with relevant legislation and the environment was not suitable to meet the needs of people living with dementia. We asked the registered provider to take action to address these areas.

This inspection found continued breaches of Regulations 11, 12, 15 and 17 as well as additional breaches of regulation 10 and 14 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded

Medication was not administered safely. Risk assessments and care plans were not followed for the safe administration of one person’s medicines. Staff failed to protect one person from a known risk of harm putting this person’s health and safety in danger. Instructions provided by a GP for the administration of medication were not followed. Records relating to medicines were not always kept up to date in a timely manner.

We found that parts of the service and equipment in use were not clean. There were ongoing risks identified with regards to infection control. Eight call bell cords were found to be tied up in toilets and communal bathrooms near to people’s bedrooms. This meant people were placed at unnecessary risk as the ability to call for help in an emergency had been restricted. Rooms containing hazardous equipment and substances were not secure. The management of health, safety and infection control was poor.

People were not consistently supported to have maximum choice and control of their lives. People were not always supported in the least restrictive way possible. Bedroom doors were locked at the service and this restricted people from gaining access to their bedrooms and possessions as and when they wished. Policies and systems relating to the Mental Capacity Act and Deprivation of Liberty safeguards in the service were not robustly followed.

The registered provider’s statement of purpose identified that the home is able to support people living with dementia. However, we found that the environment was not dementia friendly and limited adaptions had been made to aid and support people who were living with dementia.

People’s privacy was not ensured as records were not held securely at the service. People’s rights to choice, privacy and dignity were not always respected.

People were not always protected from the risk of malnutrition and dehydration. Where advice and guidance had been sought from health professionals this had not always been followed. Charts which were in place to record and monitor people’s food and fluid intake were not always completed effectively. Information relating to people’s fluid intake was not always completed in detail to accurately reflect what they had consumed. Food and fluid charts were not consistently totalled to accurately assess whether people had received adequate food and fluids to protect them from the risk of dehydration and inadequate nutrition.

The quality assurance systems in place were not effective. We found continued issues as part of our inspection relating to the analysis of accidents and incidents and the accurate completion of supplementary charts and care records at the service. Information analysed regarding accidents and incidents was not robust, There were no actions recorded to identify that the registered provider had considered how to minimise or respond to any risks, patterns or changes required to people’s care needs. Quality assurance systems used by the registered provider had not identified issues we raised as part of this inspection.

The CQC was not notified as required about incidents and events which had occurred at the service.

Care plans varied in detail and did not always accurately reflect the support people required to keep them safe. People’s needs were not always assessed and planned for to ensure they were met. One person had a behaviour chart in place which had been completed by staff. However no assessment or care planning documentation had been completed for this area of need. Records did not protect the person from the risk of known verbal and physical abuse from others. However, we noted that care plans to support people living with dementia had improved and offered guidance to staff on how best to support the person’s lived experience.

The registered provider had a complaints policy and procedure. Records did not always evidence verbal complaints received and correspondence issued by the service. We spoke with the manager and registered provider regarding the content, tone and language used in correspondence as this was not always appropriate.

The registered provider had clear policies and procedures in place for reporting any concerns they had about the safety and well-being of people they supported. The majority of people we spoke with said they were happy with the service that they received and that they felt safe. Observations showed that staff took time with people and were kind in their approach and manner. Throughout our visit observations showed that people were actively engaged in hobbies and interests.

Staff had been employed following appropriate recruitment checks that ensured they were suitable to work in health and social care. Staffing levels were continuously reviewed to ensure people were safely supported.

Staff had attended training sessions in areas such as moving and handling, safeguarding adults, equality and diversity and dementia to update their knowledge and skills. Staff confirmed that they felt supported by the manager and had the opportunity through their supervision to talk about areas of development. Records confirmed that supervisions and team meetings had been held at the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.