About the service

OSJCT Patchett Lodge is a residential care home, it is registered to provide personal care for up to 30 older people. There were 28 people living at the home at the time of the inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service

• People told us they were happy at the home. They said that the staff were kind, friendly and supported them in a way which respected their dignity.

• There were enough staff to meet people’s needs and staff had received the training and support needed to provide safe care. The registered manager had completed checks to ensure that staff were safe to work with people living at the home.

• Care plans accurately reflected people’s care needs and supported staff to meet those needs in a person-centred way. Risks to people had been identified and action taken to keep people safe. Medicines were safely managed.

• The home was clean and staff worked to minimise the risk of infection. The environment was well maintained and signage supported people’s independence.

• The registered manager had taken effective action to improve the quality of care people received following our last inspection. There were systems in place which monitored the quality and safety of the care provided and action was taken to rectify any concerns raised. The views of people living at the home were used to drive improvements in the home.

Rating at last inspection

At the last inspection the service was rated as Requires Improvement (report published 22 September 2017). At this inspection we found the provider and registered manager had made the necessary improvements.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about this service until we return to visit as per our reinspection programme. If any concerning information is received, we may inspect sooner.

We completed this unannounced inspection on 13 July 2017.

OSJCT Patchett Lodge can provide accommodation and personal care for 30 older people. There were 22 people living in the service at the time of our inspection.

The service was run by a charitable body who was the registered provider. At this inspection the company was represented by an area operations manager. There was a registered manager in post. 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. In this report when we speak both about the charitable body and the registered manager we refer to them as being, ‘the registered persons’.

At our last inspection on 22 December 2015 we found that a number of improvements needed to be made to ensure that people consistently received a safe and responsive service. The improvements included making sure that medicines were administered in the right way. This entailed care staff checking that people were taking medicines that had been given to them. It also involved making sure that when patches were used to administer medicines they were placed on different areas of a person's skin. This is necessary so that the patches do not result in people developing sore skin. In addition to these shortfalls, we also found that people needed to be offered more opportunities to enjoy participating in social activities. At this inspection we found that each of these particular concerns had been addressed.

However, at this inspection we also found that other concerns needed to be addressed. We noted that full background checks had not always been completed before new staff were employed. In addition, we found that on four recent occasions staff had not correctly recorded each occasion when a medicine had been dispensed. A further concern was that care staff had not received all of the training the registered persons considered to be necessary. Furthermore, some of them did not have all of the competencies they needed including knowing how best to support people to have enough hydration. In addition, there were shortfalls in the arrangements used to ensure that people always had enough to drink. The shortfalls had resulted from care staff not consistently following the registered persons’ procedures that were designed to ensure that people always had enough hydration. Although in practice people had received the support they needed to drink enough, oversights in following agreed procedures had increased the risk that this assistance would not be reliably provided. We also concluded that more robust quality checks were needed to enable problems to quickly be put right. These included more promptly addressing defects in the accommodation.

Our other findings were that care staff knew how to safeguard people from situations in which they might experience abuse, there were enough care staff on duty and people had been helped to avoid preventable accidents. In addition, people had been assisted to receive all the healthcare attention they needed.

Whenever possible people had been helped to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had ensured that people only received lawful care.

Care staff were kind and compassionate. People’s right to privacy was promoted and confidential information had been kept private.

People had been consulted about the care they wanted to receiv

The inspection took place on 22 December 2015 and was unannounced.

OSJCT Patchett Lodge is registered to provide accommodation and personal care for up to 30 older people. There were 27 people living at the service on the day of our inspection.

There was a registered manager in post at the time of our inspection. 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 the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. No one at the time of our inspection had their freedom restricted under a DoLS authorisation.

People were kept safe because staff undertook appropriate risk assessments for all aspects of their care and care plans were developed to support people’s individual needs. People were supported to make decisions about their care and treatment and staff supported people to maintain their independence.

The registered manager ensured that there were sufficient numbers of staff to support people safely. People were cared for by staff who had knowledge and skills to perform their roles and responsibilities and meet the unique needs of the people in their care. Staff received feedback on their performance through supervision and appraisal

People were not always given their medicine safely and there were errors and omissions in the medicine administration charts. People had their healthcare needs identified and were enabled to access healthcare professionals such as their GP, community nurse and hospital doctor. Staff supported people to have a balanced and nutritious diet.

People were not always treated with dignity and respect, although most staff were kind, and caring and sensitive to people’s individual needs. People were not supported to follow their hobbies and past times and there was little provision of meaningful activities.

The registered provider had robust systems in place to monitor the quality of the service, including regular audits and feedback from people, their relatives and staff. The service had received recognition from the provider for areas of good practice.

Prior to our inspection we reviewed all the information we had received from the provider about the home. As part of our inspection visit we spoke with six people who lived at the home. We also spoke with the manager and four staff members.

People told us staff were responsive to their changing needs. One person said, “The home is good. Staff care for me well and I get on well with other people in the home.” Another person told us, “Personal care is good. I don’t have a lot to complain about.”

We found people were supported to undertake a range of activities. One person said they liked trips out and were taken out to local clubs. The person also told us, “I feel safe and well cared for by the home and well supported by the staff members."

People told us they enjoyed the food provided and there was always plenty to drink when they wanted it. One person said, “The meals are nice and the staff tell me what the choices are each day.”

Staff we spoke with said they felt they had the right levels of management support, supervision and training to meet people’s needs.

There were systems in place for the provider to regularly monitor and assess the quality of care people received. The home owners and manager demonstrated they took action to address any issues or concerns raised and learned lessons from them.

People spoke positively about the care and support they received. They told us they liked living there and staff supported them to make choices and decisions about the care and treatment.

People said staff always asked them what they wanted to do or what they wanted to eat or drink. One person said, “No matter their role, they always ask you, how are you today?” Another person said, “If I don’t like something [food] they say we have such and such and so and so, what would you like?”

People told us they were involved in decisions about the home and engaged in activities. One person said, “We have an art group. I love that very much.” Another person said, “We have a say on what goes on. I’m looking forward to the tearoom opening.”

They told us they felt valued and staff listened to them. We asked them if they knew how to complain if they were not happy. One person said, “I have a moan at the girls from time to time, but I don’t need to complain.”

People told us they could have use of a day centre adjoined to the service, which was run independently. They said there were other activities that took place within the home that they could enjoy just as much, for example cake making, playing dominoes and music nights.

People said they felt safe living in the home and with the people that cared for them.

One person said, “There is always someone to help.”

People were very complimentary about the staff. They said they felt there were sufficient staff numbers to meet their needs.