North Cumbrian care home ‘requires improvement’ after first inspection

Virginia Lodge Care Home, Old Road, Longtown. Picture: Google Maps

A north Cumbrian care home has been told it “requires improvement” after its first inspection.

Virginia Lodge Care Home, on Old Road in Longtown, was first registered with the Care Quality Commission in 2019, with the first inspection taking place on August 23.

In the inspection report published earlier this month, when rating whether the care home was “well-led”, “safe” and “effective”, inspectors said it “requires improvement”.

They also said the care home was “good” in the areas of being “caring” and “responsive”.

The care home provides personal care for 18 people aged 65 and over, with the capacity to support up to 32 residents.

Is the service safe?

“Requires improvement” in this area means some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

Preventing and controlling infection/using medicines safely:

Systems were not sufficiently robust to protect people from the risk of COVID-19. Staff were not wearing masks on the first day of the inspection. The registered manager believed the risks were managed and masks impaired communication to people living with dementia.
The screening of visitors to the home was insufficient to eliminate those people who may have contracted the virus. Relatives confirmed they had taken tests prior to their arrival in the home but had not been requested to show the results. One relative said, “I do a lateral flow test. They don’t ask me for the result but I tell them.”
The registered manager had put in place arrangements for staff testing and at a staff meeting in June noted to staff that testing rates had reduced. Staff testing records showed not all staff had been tested in line with government guidance.
The storage of medicines was not always safe. The inspector found the door to the care office was unlocked on one visit and the medicine cabinet was also unlocked on the two visits. Medicines which were subject to greater controls were not stored in an appropriate way.
The disposal of medicines did not follow national guidance.

Inspectors found no evidence that people had been harmed however, systems were either not in place or robust enough to demonstrate safety was effectively managed. This placed people at risk of harm.

Following the first day of inspection CQC asked a specialist nurse to provide infection prevention and control advice and support to the registered manager. The registered manager was given a list of priority tasks and had begun to work through them.
The registered manager, following the conclusion of visits to the home, provided a photograph to show they had improved the security of medicines.
Guidance to staff on when to administer as and when required topical medicines was not always available. The registered manager immediately put the guidance in place.
Staff administered people’s oral medicines in a safe manner.

Systems and processes to safeguard people from the risk of abuse:

People were protected by staff who knew them well and understood when they needed to raise concerns.
Staff had received training on how to safeguard people. They felt able to raise concerns with the registered manager.
Although some people were not able to speak for themselves, inspectors observed they were comfortable in the presence of staff.

Assessing risk, safety monitoring and management:

Risks to people were well managed. Staff understood people’s individual risks and what steps to take to reduce accidents or incidents.
Relatives said people were safe in the home and used words such as ‘very safe’.
Processes were in place to manage any risks within the building. Fire safety checks were up to date. Gas and electricity supply checks were in place and in date.

Staffing and recruitment:

Staff underwent a robust recruitment process before they were employed in the service. Checks were carried out on the backgrounds of prospective staff to make sure they were suitable to work in the home.
The registered manager explained that due to the location of the service and a national shortage of carers, it was difficult to employ staff. Staff who had been recruited during the pandemic had all left the service. Rotas showed there were enough staff on duty to meet people’s needs.

Learning lessons when things go wrong:

The registered manager was open to learning lessons about people, their needs and new systems.
There were no specific incidents in the service from which lessons could be learned.

Is the service effective?

A rating of “requires improvement” in this area means the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

Was the service working within The Mental Capacity Act 2005 (MCA)?

The service was not working within the MCA. Applications to the local authority to deprive people of their liberty had not been made prior to the inspection.
The service had not followed guidance in relation to the use of bed rails.

Inspectors found no evidence that people had been harmed however, systems were either not in place or robust enough to demonstrate the service was effective. This placed people at risk of having unnecessary restrictions in place.

During the inspection, the registered manager began to make improvements and take the necessary steps to make applications to the local authority to deprive people of their liberty.

Assessing people’s needs and choices; delivering care in line with standards, guidance and the law:

People’s needs and choices were assessed in line with national standards before they were admitted to the home. One relative confirmed this had taken place during the pandemic in a safe and socially distanced manner.
The registered manager had consulted with people and their relatives to discuss how people’s needs could be met.
Staff supported people’s oral health and encouraged them to maintain a healthy mouth.

Staff support: induction, training, skills and experience:

Staff were supported through a period of induction to become familiar with people’s needs and the workings of the home.
The registered manager provided a training programme for staff to support them in their respective roles. Staff also had regular supervision meetings with their line manager to reflect on their practice and raise any concerns.

Supporting people to eat and drink enough to maintain a balanced diet:

Staff provided the required support to help people eat and drink. The service had a two-week menu in place which offered a choice of meals each day. People were given a choice before each meal but could change their mind at the dinner table. Alternatives were provided by staff if a person chose not to eat their meal.
Staff provided adapted cutlery to assist people to eat. Although people were unable to tell inspectors about the menu, they observed people enjoying their meals. Staff offered people help to cut up their food to support them to enjoy their meal.
Staff provided people with regular drinks and encouraged them to consume fluids to maintain their hydration.

Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier lives, access healthcare services and support:

The registered manager and staff worked with other agencies to meet people’s care needs. Records showed staff sought advice and support from other healthcare professionals.
One relative described the improvement to a person’s legs following staff actions when they had sought advice from healthcare professionals.
Staff prepared electronic handover information for the next shift due to come on duty. The information directed their colleagues to other records about the involvement of outside professionals to provide consistent care.

Adapting service, design, decoration to meet people’s needs:

The service required updating to meet the needs of people living with dementia in line with best practice. The registered manager had a plan in place to improve the building to meet people’s needs.
The provider ensured people were comfortable with appropriate adaptations including seating and equipment designed to reduce risks and encourage independence. Handrails were available for people to use along the corridors.
The registered manager was aware of the repairs and redecoration which needed to be carried out to the building. They explained that due to the pandemic they had experienced significant difficulties in getting tradespeople in to do the work.

Is the service caring?

A rating of “good” means that people were supported and treated with dignity and respect; and involved as partners in their care.

Ensuring people are well treated and supported; respecting equality and diversity:

Staff ensured people were well treated. They spoke to people in gentle tones, provided reassurance if anyone became distressed and knelt down so they could speak to people face to face.
Irrespective of a person’s capacity or ability staff treated people equally and afforded people the same standards of care. Inspectors observed people were dressed appropriately in matching clothes and were well presented.
Relatives spoke about the kindness of staff. Inspectors observed one member of staff who provided exceptional care. They said, “I like to treat people as if they were my own parents.”
Staff had engaged people’s relatives to support them make decisions.

Supporting people to express their views and be involved in making decisions about their care:

Staff provided people with the opportunity to make decisions throughout the inspection and supported them in their choices. This included providing constant supervision for one person who wished to walk around the home.
Although people were not always able to speak for themselves, staff listened to people’s comments and paid due regard to their behaviour to support them in the right way. Respecting and promoting people’s privacy, dignity and independence.
Staff respected people’s privacy and dignity. Personal care took place behind closed doors. Staff knocked on people’s doors before entering.
Staff supported people to be independent. Care plans explained what people were able to do to support themselves.
People’s personal information was stored on a password protected computer system which was only accessible by authorised staff.

Is the service responsive?

A rating of “good” in this area means people’s needs were met through good organisation and delivery.

Planning personalised care to ensure people have choice and control and to meet their needs and preferences:

The service had care plans in place which described in detail how to meet individual needs and preferences.
Staff regularly reviewed care plans to ensure they reflected people’s needs.
Staff were able to describe people’s likes and dislikes.

Supporting people to develop and maintain relationships to avoid social isolation; support to follow interests and to take part in activities that are socially and culturally relevant to them:

Staff had supported people to maintain relationships with their relatives during the pandemic. Relatives confirmed they had used window visits to maintain contacts.
The activities coordinator employed by the registered provider was not at work during the inspection. The care staff had worked together and provided some activities, including playing dominoes and having meaningful conversations with people. Kitchen staff provided baking opportunities once per week.
Staff described a recent visit from an organisation which worked with people to increase their movement to music. One member of staff said people had joined in and enjoyed the experience.

Meeting people’s communication needs:

Since 2016 onwards all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard (AIS). The standard was introduced to make sure people are given information in a way they can understand. The standard applies to all people with a disability, impairment or sensory loss and in some circumstances to their carers.

Staff had put in place communication plans to describe how best to meet people’s communication needs. This included people’s preferences regarding the use of their glasses and hearing aids to assist communication.
Information about residents’ meetings and residents’ newsletters were provided in larger print.
The provider had an AIS policy in place which described to staff what they needed to do to meet the required standard.

Improving care quality in response to complaints or concerns:

The registered manager had not received any complaints about the service but had appropriately responded to concerns raised about service delivery to one person.
Relatives told inspectors they had not needed to make a complaint about the service. One relative said, “No I have no complaints.”

End of life care and support:

Staff had addressed people’s end of life care preferences. They had worked with other professionals to consider if people wanted to be resuscitated in the event of their heart stopping.
People who wished to pass away in the care home had done so with staff being supported by the community nursing team.

Is the service well-led?

A “requires improvement” rating in this area means the service management and leadership were inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements:

Systems to measure quality performance were not always accurate. For example, auditing of falls had not taken place.
The registered manager had not put all the national guidance in place to reduce risks.

Inspectors found no evidence that people had been harmed however, systems were either not in place or robust enough to demonstrate the service was well-led.

The registered manager took a hands-on approach and had recently worked nightshifts to cover for absent staff which took time away from their management role.

The registered manager had fulfilled their statutory duties and made the required notifications to CQC.

Promoting a positive culture that is person-centred, open, inclusive and empowering, which achieves good outcomes for people: How the provider understands and acts on the duty of candour, which is their legal responsibility to be open and honest with people when something goes wrong:

The provider’s policies and procedures were indicative of a person-centred culture to achieve good outcomes for people.
Staff spoken to were clearly committed to providing person-centred care.
Staff felt supported by the registered manager. Relatives felt able to approach the registered manager and voice any concerns.
The registered manager understood their duty of candour responsibilities.

Engaging and involving people using the service, the public and staff, fully considering their equality characteristics; Continuous learning and improving care:

Relatives had been asked for their views during the pandemic. The responses to the questionnaires were positive.
The registered manager explained they had difficulties in getting all the staff together to seek their views during the pandemic but had tried to seek the views of staff about the service in smaller groups. The registered manager did not wish to increase the risk of COVID-19 transmission when bringing staff together and not all staff were able to participate in online meetings.
The registered manager had an action plan in place to improve the safety and quality of the service. The plans covering a two-year period were on display to visitors to the home. The registered manager’s ability to make progress had been significantly impeded by the requirements of working during a pandemic.

Working in partnership with others:

The service was working with other health and social care professionals who were involved in people’s care.
People’s care records showed involvement and guidance from other agencies such as GPs and the care home support team.