Background to this inspection
Updated
15 September 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
This inspection was carried out by one inspector over two days.
Service and service type
Adrian lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
We used information gathered as part of monitoring activity that took place on 7 April to help plan the inspection and inform our judgements. We also reviewed the information shared with us by the local authority who conducted their review of the service in September 2021.We used all this information to plan our inspection.
During the inspection
We spoke with three staff on duty. We spoke with a visiting engineer. We spoke with three people using the service. We observed people throughout the day in terms of their care and support and across mealtimes. We reviewed records including medication records. We reviewed arrangements for cleaning and maintaining the service
We visited the following day to review additional records and reviewed two care plans. We met the regional manager and had further discussions about the service and observe and spoke with people using the service.
After the inspection
We continued to seek clarification from the provider and spoke to staff to validate evidence we found. We spoke with two relatives about their experiences of the service.
Updated
15 September 2022
Adrian 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. Support is provided over twenty-four hours with both day staff and a sleep-in staff at night who can be summoned in an emergency. The service can accommodate up to ten people who have a diagnosed mental health condition. It does not provide nursing care. At the time of our inspection there were ten people living permanently at the service.
People’s experience of using this service and what we found
People were supported by staff who were familiar with their needs and were observed as being kind and responsive. People spoken with had some opportunity to go out and develop their independence with staff support.
Some people's needs had changed which meant they required additional support to stay safe. This was not reflected in the staff hours provided by the service. Three people had some one to one hours when staff supported them to go out or complete tasks within the service. Other people had shared support and staff had limited amount of time to spend with them.
Not all risks were appropriately assessed and monitored to ensure people were kept safe. People lived in a poorly maintained environment which made it more difficult for staff to keep clean. Facilities were poor.
Individual risks were not clearly identified and planned for. For example, staff did not keep fluid charts where people were prone to infection. Staff had not taken fully into account the recent hot weather and how this might impact on people’s general health and wellbeing.
People were not fully supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; For example staff had sought consent to keep the main fridge in the kitchen locked but had not documented the clear rationale for this or considered if this was the least restrictive option.
Medicines were safely managed but people even those who took their own medicines were required to go to the medicines room which was not a very person-centred approach. We have made a recommendation about monitoring the use of medicines prescribed to be administered when required.
People discussed their care needs with staff regularly, but daily care notes and monthly reviews did not clearly focus on people ‘s wellbeing and mental health or identify new or unmet need.
Governance and provider oversight was poor which had led to a lack of investment and quality improvement. The last CQC inspection to this service was on 4 October 2018. Although rated good safe was rated as requires improvement and we found robust actions were not taken to address our concerns. During a more recent inspection by the local authority in 2021 and a CQC review of the service in 2022 we found a continued lack of effective monitoring or action to address the issues found.
The registered manager was highly regarded by staff and people using the service and was engaging with health care professionals to get people’s needs reassessed where changes were noted in their physical and mental health exacerbated by the COVID 19 pandemic.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 14 December 2018.)
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
This inspection was prompted by a review of the information we held about this service. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.
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 see what action we have asked the provider to take at the end of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Adrian Lodge on our website at www.cqc.org.uk.
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 the environment, quality monitoring and assessing risk at this inspection. Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.