This inspection took place on 6, 12 and 13 June 2018 and was unannounced. This was the first inspection undertaken since the service was registered in December 2017. The inspection was prompted in part by notifications sent to us that raised concerns about people’s care.Lofthouse Grange and Lodge is a ‘care home’. 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. Lofthouse Grange and Lodge accommodates up to 88 people over two communities, referred to as ‘The Lodge’, which accommodates people living with a dementia related condition and ‘The Grange’, which accommodates people requiring residential care. There were 72 people living in the home when we inspected.
At this inspection we found four breaches of the Regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 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.
The overall rating for this service is ‘Inadequate’ and the service is 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.
There was a registered manager in post at the time of the inspection. 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 were not enough staff to meet people’s needs effectively. There was a high turnover of staff and staffing levels were impacted due to sickness and absence. People, their relatives and staff told us they had concerns with staffing levels. There was a high number of agency staff used with the service, and people, their relatives and staff told us they had concerns about continuity of care and competence of agency staff.
Systems and processes around medicines management were not safe. Specifically, we found concerns with the safe storage, administration practice and documentation of some medicines.
Safeguarding referrals were not always made appropriately and there were a high level of falls and incidents which had not been managed effectively. This meant appropriate action had not been taken to manage known risks effectively and reduce the possibility of their recurrence
We found concerns over the cleanliness of the service through our observations and what staff told us. We found malodorous water jugs and dirty fridges. Wheelchairs and pressure mats were often unclean. Automatic hand gel and soap dispensers across the service were not working which put people at risk of cross contamination. Cleaning rotas were sometimes incomplete and had not been reviewed.
The inadequacy of the governance arrangements meant shortfalls were not identified and subsequently preventative action was not taken to mitigate risks. The shortfalls we identified during our inspection had either not been highlighted by the providers internal quality assurance processes, or had been identified with action taken but these actions were not sustained.
People, their relatives and staff told us they thought that permanent staff received good training. However, they said that agency staff were not always sufficiently skilled to meet people’s needs.
Staff gave mixed feedback on their levels of support through supervisions and appraisals. Staff were recruited safely, with appropriate identity checks and references undertaken.
The service was compliant with and acted under the principles of the Mental Capacity Act (2005).
We observed mealtimes and these were pleasant experiences, however, recording of people’s dietary needs was not always up to date.
People told us staff were kind caring and compassionate, however due to other factors the service was not always able to deliver a wholly caring service. Staff were able to describe how they would protect people’s dignity and privacy, as well as promote their independence.
People were assessed appropriately before using the service. Some care plans we reviewed contained good person-centred plans specific to their needs, however in other care plans the quality of information recorded was not always consistent.
Whilst activities were provided by the service and people enjoyed these, some people felt they could do more. Staff said they could not always give people the stimulation they felt they needed. Recording of activities was not always consistent.
There was a complaints process and policy in place. People and relatives were aware of the process but gave mixed feedback about it. Complaints we reviewed were responded to in line with the policy.
Staff told us they were not confident in the leadership of the service and that morale was low. People and their relatives gave mixed feedback on the management of the service.
You can see what action we told the provider to take at the back of the full version of the report.