St Aidan Lodge Residential Care Home

We found the following examples of good practice.

Measures were in place to prevent visitors from catching and spreading infection. The provider had created a welcoming and homely visiting pod for relatives. The home deep cleaned the pod after each visit.

Professional visitors were robustly screened for COVID-19. Screening included temperature checks, completion of a health declaration, and hand sanitisation in a separate allocated washroom.

The home encouraged telephone and video contact wherever possible. The provider had purchased a computer on wheels with a very large screen. This provided easily accessible and good quality video contact for people and their relatives.

The provider had created a separate wing to accommodate anyone who was being isolated during the pandemic. The wing had its own entrance and fire exit, and was separated from the main building with a keycode system. When in use, designated staff were allocated to work on this wing only.

The home had adequate supplies of PPE. Fully stocked PPE stations were located throughout the home. Laminated signage was on the walls to remind staff how to put on, take off and dispose of PPE safely.

Staff had completed infection prevention and control (IPC) training. All staff were observed to be wearing appropriate PPE and were bare below the elbow to assist with good hand hygiene. The registered manager carried out ‘spot checks’ to ensure staff complied with best practice guidance.

The home was clean and tidy throughout, and had been well maintained during the pandemic. A thorough cleaning schedule was in place which included additional cleaning of frequently touched areas. The provider had purchased an electrostatic sprayer for deep cleaning.

The provider had up to date IPC policies and procedures in place. The provider carried out regular IPC audits and offered good support to the registered manager.

This inspection took place on 31 October and 2 November 2018 and the first day was unannounced.

At our last inspection on 7 and 9 March 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. The home was meeting the requirements of the fundamental standards.

People, relatives and staff felt the service was still a safe place. People were protected from the risk of abuse because staff understood how to identify and report it.

People told us there were always enough staff on duty and that their needs were attended to promptly. We observed this to be the case during our visits.

People received their medicine safely and were supported to access the support of health care professionals when needed.

Where risks were identified to people who used the service or to the environment these were assessed and plans put in place to reduce them. Accidents and incidents were analysed to identify trends and reduce risks.

People’s needs had been assessed to identify their care needs. Assessments were detailed and covered all aspects of their care needs.

Staff were well supported and received the training they needed. Training was delivered face to face and was arranged on a rolling programme to meet the requirements of the home.

People were very complimentary about the meals provided. They received a varied and nutritional diet that met their preferences and dietary needs. The service provided a range of nutritional food and drink which were adapted for different diets.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they thought the service was very caring and we observed compassionate and caring interactions between people and staff. People told us, and we observed, that care was delivered with dignity and respect and people were supported to be as independent as possible.

Care plans were very detailed and reflected people’s needs and preferences. Care plans were evaluated regularly and included meaningful information about people’s needs.

People were actively engaged in a range of activities and had regular opportunities to access the wider community. Opportunities for staff to share their hobbies and skills with people was being explored but was still in development.

Feedback on the service was encouraged in a range of ways and was positive. People told us they did not have any concerns about the service but knew how to raise a complaint if needed.

The management team were approachable and they and the staff team worked in collaboration with external agencies to provide good outcomes for people. Processes were in place to assess and monitor the quality of the service provided and drive improvement. All levels of management were highly invested in the home and committed to delivering a quality service.

Further information is in the detailed findings below.

We previously inspected St Aidan Lodge Residential Care Home on 30 April 2014, at which time the service was compliant with all regulatory standards.

St Aidan Lodge Residential Care Home is a residential home in Durham providing accommodation and personal care for up to 62 older people. There were 49 people using the service at the time of our inspection.

The service had a registered manager in place. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that there were sufficient numbers of staff on duty in order to meet the needs of people using the service, as well as to ensure premises were well maintained. All areas of the building including people’s rooms, bathrooms and communal areas were clean and odour-free. Infection control risks were well managed throughout.

The storage, administration and disposal of medicines was found to be safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE). Medicines practices we observed were patient, safe and in line with the registered provider’s policy.

Risks to people were managed through risk assessments and associated care plans. These risks were reviewed regularly and we saw when relevant information was provided by healthcare professionals this was incorporated into care planning and risk assessment.

Staff displayed a good knowledge of safeguarding principles and what to look out for in terms of indicators of potential abuse. People we spoke with, their relatives and healthcare professionals consistently told us the service maintained people’s safety.

There were effective pre-employment checks of staff in place, including Disclosure and Barring Service checks, references and identity checks.

Visiting professionals were complimentary about the knowledge and skills of staff, citing a range of examples where they ensured people’s healthcare needs were met. There was regular liaison with GPs, nurses and specialists to ensure people received the treatment they needed.

Training was relevant to people’s needs, with staff completing a range of training the registered provider considered mandatory, as well as training specific to people’s needs, for example Gold Standard Framework end of life training. Other training included: dementia awareness, infection control, moving and handling, first aid, person-centred care, safeguarding and medicines administration. Staff displayed a good knowledge of the subjects they had received training in.

Staff were well supported through formal supervision and appraisal processes as well as ad hoc support when required. Staff had a good knowledge of people’s likes, dislikes and life histories and had built a rapport with the people they cared for.

We saw people had choices at each meal as well as being offered alternatives. People spoke positively about the food they had and confirmed they could choose whether to eat with other people or in their room. We observed calm and unhurried interactions between staff and people they supported during lunchtime.

The premises were well designed for people who used the service, with aspects of dementia-friendly design in place, spacious corridors, lifting and bathing equipment tailored to people’s physical needs, and a spacious salon for hairdressing and other uses, such as visits by opticians.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA. The registered manager displayed a good understanding of capacity and we found related assessments and decisions had been properly taken and the provider had followed the requirements in the DoLS.

The atmosphere at the home was welcoming. People who used the service, relatives and external stakeholders agreed that staff were caring and compassionate.

Person-centred care plans were in place and daily notes were accurate and contemporaneous. We saw regular reviews took place, ensuring people who used the service, relatives and healthcare professionals were involved.

The service had built and maintained good community links, although there was scope to build better links with a local community centre.

Staff, people who used the service, relatives and external professionals we spoke with were positive about the registered manager in terms of their accountability and approachability.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with told us they were happy living at the home, they told us the staff working in the home were very good and kept them safe.

We saw the provider had a rigorous recruitment campaign, which when put together with the staff training and observations helped to ensure people living in the home were protected from harm.

People who lived in the home had assessments carried out prior to moving there. This helped to ensure their environment within the home was safe and appropriate to their needs.

The registered manager showed us some staff rotas. The manager showed us how she used a dependency tool to work out how many staff were required on duty each day. In addition the home had supernumerary staff working each day meaning people who used the service receive the correct level of care and support.

Is the service effective?

People's care needs were assessed before going to live at the home. We saw people were involved with the planning of their care and the level of assistance the wanted wherever possible. If this was not possible we saw friends or relatives were asked for help in the planning of care.

People's care plans were individual and person centred, detailing things like their likes and dislikes, preferences and religious beliefs.

People who lived at the home were given access to dentists, opticians, and chiropodists to help ensure their wider health needs were being met.

Is the service caring?

People who received help with personal care were treated kindly and with respect. People were happy with the care staff and we saw people's preferences being taken into account in ways like what they wanted to do during the day, what they wanted to eat and also if they wanted to spend time with visitors in private.

Is the service responsive?

People who used the service, their family, friends and other professional who worked with them were regularly asked for their views on the way the service was run. Responses to surveys were analysed and used to enable the manager to make changes to the service where needed.

Is the service well lead?

The home worked with other professionals like dentists, chiropodists and GPs to ensure people's wider health needs were met.

The staff working at the home told us they felt supported in their roles and were happy with the level of training they received. Staff were confident that any concerns or complaints they may have would be dealt with quickly, appropriately and in confidence.

The manager had a notice board in the foyer of the home which gave people who used the service and their family or friends information on the home's complaints procedure and also details of other people they could speak with if they felt their complaint wasn't dealt with satisfactorily.

The manager has also introduced an 'employee of the month'. This is based on nominations from staff, people who used the service, families and other visitors to the home.

People and staff told us that consent was gained before care was delivered and we found that the provider acted in accordance with people's wishes.

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plans. We observed that relationships between staff and people appeared to be good and people looked clean and well cared for.

People were protected from the risk of infection because appropriate guidance had been followed.

There were enough qualified, skilled and experienced staff to meet people's needs. One person said, 'There is always someone available when I need them.'

There was an effective complaints system available and a clear way of identifying complaints. We found that comments and complaints people made were documented and responded to appropriately.

When we visited the home there were 58 people living there, on two floors. We spent time talking with several people, and watched how staff gave them support and care. People were happy with the care provided. Comments included 'I like it here' and 'The staff look after me.'

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.

People's personal records were accurate and fit for purpose.