26 May 2022
During an inspection looking at part of the service
Umika Lodge is a residential care home providing personal care to up to 29 older people, some of whom are living with dementia. At the time of our inspection there were 20 people using the service.
People’s experience of using this service and what we found
People’s care was not always personalised to reflect their individual needs and preferences. People had care plans and risk assessments in place which detailed how they liked to be supported; however, care was not always delivered in line with this guidance. People were not always supported to engage in meaningful activities of their choice and information about how people were being supported with their preferred pastimes lacked detail.
The provider had made improvements to their processes for monitoring the quality and safety of the service since the last inspection. However, these systems were still not robust and had not identified the concerns we found during the inspection. The provider’s processes for checking the administration of people’s medicines were not always effective in highlighting errors.
People were protected from the risk of infection. The provider had made improvements to their COVID-19 policy and contingency planning to ensure safe processes were in place in case of any future outbreaks of infection. Staff wore appropriate personal protective equipment [PPE] and had received training in managing the risk of infection and donning and doffing.
The provider had increased staffing levels in the service since the last inspection and staff had received an induction and training relevant to their role. Staff were safely recruited and the provider had completed the appropriate checks prior to them starting work.
People were protected from the risk of abuse and staff knew how to identify and report safeguarding concerns. The provider had a process in place for responding to complaints and people and relatives told us they felt comfortable raising any issues with the management team.
The provider worked alongside other healthcare professionals in order to support people’s health needs, making referrals and seeking additional support where appropriate. People’s end of life care wishes had been considered and the relevant information recorded.
People, relatives and staff spoke positively about the culture of the service and told us the management team were approachable and supportive.
Rating at last inspection and update
The last rating for this service was requires improvement (published 30 March 2021) and there were breaches of regulation.
At this inspection enough improvement had not been made and the provider was still in breach of regulations and the service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.
Why we inspected
We carried out an unannounced inspection of this service on 12 January 2021. Breaches of legal requirements were found. The provider was asked to complete an action plan after the last inspection to show what they would do and by when to improve the safety of people’s care, staff training and oversight of the service.
We undertook this focused inspection to follow up on the action we told the provider to take at the last inspection. This report only covers our findings in relation to the Key Questions of Safe, Responsive and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Umika Lodge on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in relation to person-centred care and oversight at the service. Please see the action we have told the provider to take at the end of this report.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.