We undertook a comprehensive inspection over two days on 20 and 21 August 2018. The first day of the inspection was unannounced. On the 01 June 2018 we received information from the local authority which related to safeguarding incidents which the Care Quality Commission (CQC) had not been notified of. We contacted the provider who identified further incidents which we should have been notified of. In response to these concerns we undertook this inspection.The White Lodge is registered to provide accommodation for persons who require nursing or personal care for up to 80 older people, some of who may be living with dementia. At the time of our visit 63 people were using the service. The home is situated over three floors. There were communal lounges and dining areas with satellite kitchens on each floor with a central kitchen and laundry. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
There was no registered manager in post at the time of our inspection. The last registered manager left the service in December 2017. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are 'registered persons. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
We last inspected the service in June 2017. The service was rated Good in each domain and Good overall.
At this inspection we have found the service was not always safe, responsive or well-led. Therefore, the service has been rated as Requires Improvement in these three domains. The service remained Good in effective and caring domains. As a result, The White Lodge has been rated overall as Requires Improvement.
The registered provider failed to suitably assess risks to the health and safety of people who received care and treatment. Additionally, the service did not always do all that was reasonably practical to reduce such risks. This was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.
The registered provider failed to deploy sufficient numbers of staff to make sure that people’s care and treatment needs are met. This is a breach of Regulation 18 of the Health and Social Care Act (Regulated Activities) Regulations 2014.
The registered provider failed to operate an effective and accessible system for identifying, receiving, recording, handling and responding to complaints. This was a breach of Regulation 16 of the Health and Social Care Act (Regulated Activities) Regulations 2014.
Ineffective quality assurance systems meant that the provider could not always continuously learn, improve and innovate. Ineffective audits put people at risk of potential harm, as areas for improvement had not been addressed to mitigate risk. The provider did not always actively encourage feedback about the quality of care and overall involvement with people who use the service. This is a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.
The provider had not always notified CQC of other incidents within a reasonable time frame. This meant we could not check that appropriate action had been taken to ensure people were safe. The provider is in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.
The registered provider did not always ensure that people’s mental capacity assessments were in line with the Mental Capacity Act Code of Practice. We made a recommendation that the provider seeks guidance to ensure they are meeting these standards.
Staff were trained and understood their responsibilities in regard to the safeguarding of vulnerable adults and were able to identify signs of abuse to keep people safe.
Staff received training relevant to their roles and were supported with regular supervision and annual appraisals. Staff spoke positively of the training that they were offered and undertook.
The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff.
People received their medicines safely and on time from staff who were trained to manage medicines safely.
People were supported to maintain a healthy balanced diet. People told us the food was good and plentiful.
People using the service and their relatives commented the service was kept clean. The building was well maintained and provided a spacious environment.
Staff had developed caring relationships with people and treated people with kindness, and compassion. People were treated with dignity and respect. They were supported to maintain their independence wherever possible.
Staff spoke positively about the teamwork on units and expressed that they want the service to improve.
We identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to breaches in regulation 12 Safe care and treatment and regulation 17 Good governance, will be added to the report after any representations and appeals have been concluded.