Compton Lodge is a residential care home for up to 32 older people. At the time of our inspection there were 27 people using the service.

We carried out an unannounced inspection on the 19 and 21 September 2018. At our last inspection on 10 and 12 January 2018 the service was rated as Good. As a result of this inspection the service has been rated as Requires Improvement.

We carried out an unannounced comprehensive inspection of this service on 10 and 12 January 2018. After that inspection we received concerns in relation to the use of medicines at the home due to a controlled medicine having been given in error. As a result, we undertook a focused inspection to look into those concerns. This report covers our findings in relation to this topic and other areas we examined. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for [Compton Lodge] on our website at www.cqc.org.uk

Earlier this year, after our previous inspection, there had been a delay in following up the receipt of a prescribed medicine needed due to sudden illness. Since that time there was a recorded omission from a controlled drug register entry in August 2018, a medicine error where an incorrect medicine had been given and an error by the dispensing pharmacy which was picked up by the service, but not until after the medicine had also been given. These had fortunately not resulted in harm to anyone. Action had been taken as a result of these occasional errors and improvements had been made although errors had still occurred. The provider has changed pharmacy provider since in order to respond to errors being made by the previous pharmacy provider.

There was a registered manager in place at the time of the inspection. There had been a change since our last inspection in January 2018. The previous manager had left the provider organisation in June 2018 and had been replaced by a manager who had previously been the registered manager of another care home operated by the same provider. 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.

Staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The service was clear about obtaining consent to care and had done so in each of the care plans that we viewed. Consent was obtained from people themselves, but if they lacked capacity, and if legally permitted to do so, relatives provided signed consent. One person, of the six currently identified as lacking capacity, had a relative with lasting power of attorney (LPA) noted on their care plan. The Office of the Public Guardian registered number of the LPA was noted on the care plan, but a physical copy of the LPA had not been obtained from the relative, which was being followed up by the service.

There were systems in place to safeguard people and staff had a good understanding of keeping people safe from harm or abuse. Risk assessments formed part of each person’s care plan and covered risks that staff needed to be aware of to keep people safe.

People had a Personal Emergency Evacuation Plan on their care record (PEEP) which informed staff how to support the person should evacuation be necessary in the event of fire. The home was undergoing a renewal of the fire alarm system at the time of this inspection, during which the current fire alarm system was still in use.

Recruitment practices ensured staff were appropriately checked prior to employment to ensure they were suitable to work with the people using the service. There were sufficient staff available and deployed to meet people’s needs and staff were trained about their work.

People were supported to eat drink and ma

Compton 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.

Compton Lodge is a residential care home for up to thirty two older people, each accommodated over three floors with communal living space on the ground floor. At the time of our inspection there were twenty six people using the service.

This unannounced inspection took place on 10 and 12 January 2018. At the last inspection on 19 January 2016 the provider met all of the legal requirements we looked at and was rated good.

At this inspection we found the service remained Good.

The service had a registered manager in place. 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 and associated Regulations about how the service is run.

All staff we spoke with understood their duty to protect the people in their care. Staff knew what to do in order to protect people from abuse and how to identify and minimise potential risks to people’s health and welfare. Medicines were safely administered, managed and stored.

There were sufficient staff to meet people’s needs. People, and relatives, told us that they were happy and that staff provided safe and good care.

Care staff undertook training which helped them to carry out their role. The supervision and appraisal system also supported them to carry out their work.

People were supported to consent to care and the service operated in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, consulting with people and their relatives about their wishes and needs.

People were supported to maintain good health. People had access to health care services whenever this was needed and appropriate advice was obtained from healthcare professionals when required. People received a nutritionally balanced diet to maintain their health and wellbeing.

The service carried out assessments of people’s needs before they moved in to make the right decision about whether the service could provide the care and support that people needed. Care plans described each person as an individual and were tailored to their unique needs. Care plans were regularly reviewed and any changes to people’s needs were recognised and action was taken to respond.

The service had a clear management structure in place. The service had a range of quality assurance, consultation and monitoring systems in place. The provider listened and responded to the views of people who used the service, relatives and other health and social care professionals.

We carried out an unannounced inspection on the 19 January 2016. At our last inspection 24 February 2015, we found that improvements were required in relation to risk assessments that were not person centred and not reviewed regularly. Care plans were not being followed and were also not reviewed regularly and a fire risk assessment had not been carried out an annual basis.

At this inspection we saw improvements had been made. We saw that risk assessments and care plans were person centred and reviewed regularly, care plans were being followed and an annual fire risk assessment had been carried out in June 2015.

Compton Lodge is a residential care home for up to thirty two older people. At the time of our inspection there were twenty nine people using the service.

There was a registered manager in place 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 systems in place to safeguard people and staff had a good understanding of the different types of abuse and how they would look out for signs.

Risk assessments formed part of the person’s agreed care plan and covered risks that staff needed to be aware of to keep people safe.

People had a Personal Emergency Evacuation Plan on their record (PEEP). Their PEEP identified the level of support they needed to evacuate the building safely in the event of an emergency.

Recruitment practices ensured staff were appropriately checked prior to employment to ensure they were suitable to work with the people using the service.

There were sufficient staff available and deployed to meet people’s needs.

Medicines were stored, administered and recorded appropriately by staff who had undertaken relevant training.

Staff received training and support to help them carry out their work role and demonstrated good knowledge on the subjects they were asked about, including promoting independence, choice, dignity, engagement and person centred care.

Staff had received training in the Mental Capacity Act 2005 (MCA) and the Depravation of Liberty Safeguards (DoLS) .They able to describe people’s rights and the process to be followed if they were identified as needing to be assessed under DoLS.

People were supported to eat drink and maintain a balanced diet. There were menus on display in pictorial form. People were supported appropriately during meal times.

People were supported to keep well and had access to the health care services they needed.

We saw that staff received training on ‘Rights, Choice and Risks’ and this also included equality and diversity. Aspects of peoples unique needs relating to this were included in peoples care plans, including race, sexual orientation and beliefs.

A copy of the complaints leaflet was on display on the notice board at the service. Staff knew how to support people appropriately to make a complaint.

There was evidence of regular audits and spot checks undertaken by the management team, including checks of care records, communication and staff practice.

There were opportunities for people’s voices to be heard. Meetings were organised for people using the service and their relatives.

This unannounced inspection took place on 24 February 2015. Our previous inspection took place on 12 November 2103 and we found the service met the regulations inspected.

Compton Lodge is a residential care home for up to 32 people over 65 years of age. Each person has their own bedroom and has access to assisted bathrooms and walk in showers. There is a large communal lounge, a smaller lounge and a separate dining room. At the side of the home there is a large garden area. The home is situated in a residential area near Swiss Cottage in Camden, North London. At the time of our inspection there were 29 people using the service.

There was a registered manager in place at the time of our visit. 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.

People were not always supported safely as risk assessments were not person centred and did not always demonstrate how people should be supported safely. They were not always easily accessible and were not reviewed in accordance with the provider’s documentation.

There was a lack of involvement of people and their relatives in care planning. Some people and their relatives told us they were not involved in reviews of care plans and a survey of people using the service undertaken by the provider indicated the same. We also noted that the care records system used were not person centred, meaning individually focused on the needs of the person. They were also not regularly reviewed in accordance with the provider’s own documentation.

Medicines were stored and administered safely and some people managed these themselves. However some staff had not had the required competency assessment for the administration of medicines.

Staff had adequate skills and knowledge to support people effectively and we saw evidence of training in staff files that we looked at. Staff told us the induction they received was good and covered all the core training courses as well as including a period of shadowing more senior staff.

Staff had some understanding of the Mental Capacity Act 2005 and how to support people using the principles of the Act. However staff we spoke with had limited understanding of the Deprivation of Liberty Safeguards (DoLS) and changes that had occurred as a result of the Supreme Court judgement in 2014. DoLS exist to protect the rights of people who lack the mental capacity to make certain decisions about their own wellbeing. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way. We noted that only a quarter of the staff team had undertaken training concerning DoLS. There were no applications for DoLS at the time of our visit. This lack of knowledge of the DoLS may have led to people being unlawfully deprived of their liberty.

We saw three care files and each person had “Do Not Attempt Resuscitation” (DNAR) forms in their records to record their wishes on this matter. However on two of the files there was no evidence that people and their relatives were involved in the discussions regarding this. This could have meant that people and their relatives may not have had a good understanding of the implications of this instruction should the need for resuscitation arise.

Staff developed positive and caring relationships with people. There was a warm and caring atmosphere and we saw good interaction between staff and people using the service. Staff demonstrated dignity and respect and encouraged people to be independent when supporting them with activities. We saw one person being supported to walk around the garden and other staff were seen sitting beside people talking and laughing.

We saw that there were aspects of the service that were responsive, including the activities people were offered and the way the service supported people to continue with activities they had done before they came to the service.

The registered manager was friendly and approachable and was supported well by the deputy manager, the quality assurance manager and the area manager. They recognised that the care plans and risk assessment systems in place were not adequate and told us there were plans in place to make changes and improvements.

At this inspection we found breaches of regulations in relation to care and welfare and assessing and monitoring the quality of service provision. You can see what action we told the provider to take at the back of the full version of the report.

We inspected Compton Lodge on the 12 November 2013. We spoke with the manager, deputy manager and a number of staff. We spoke with people using the service and observed care being provided. At the date of the inspection there were 32 people living at the home. We looked at people’s care records and other records relating to the service.

The home was bright, warm and clean. We saw that people were relaxed and appeared to get on well together. We saw staff providing care and support in a friendly unhurried way. People described staff as “gentle,” “polite” and “very nice.” They were generally happy with living at the home. One person told us “If I didn’t like it here, I’d leave.” The home arranged appropriate activities for people using the service.

The provider maintained both paper and electronic records. The electronic records indicated that reviews of some people’s care plans were overdue.

Staff members were suitably inducted and trained. They told us they were appropriately supported by the provider to carry out their duties.

Although people were given the opportunity to comment on the quality of the service, there had been no residents’ meetings for several months. The provider had conducted quality surveys of people using the service, but there had been delays in passing the results back to the home for necessary action.

We last inspected the home in July 2012 and our report was published in October. We found that the provider was not meeting the standard relating to Outcome 21, Records. We judged that the provider’s failure to meet the standard had a minor impact on people using the service. We set a compliance action requiring the provider to take steps to meet the standard.

This report is supplemental to our report published in October 2012.

We made this visit on the 31st January 2013 to check that the provider had made the necessary improvements to meet the standard. We inspected a number of paper and computer records relating to people using the service and we spoke the home’s manager. On this occasion, we did not speak with any people using the service. We found that the provider had taken appropriate action and was compliant with Outcome 21.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an additional CQC inspector and an Expert by Experience; people who have experience of using services and who can provide that perspective.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People told us that the home was “very comfortable,” and that they had no complaints they can think of. One person said the food at the home was “lovely.” Another said that it “couldn’t be much better.” All the residents that we spoke with said they felt safe in the home and had not experienced any incidents of abuse. One resident said, ‘the staff are very good and kind to everyone.’ and another described the manager as “absolutely wonderful.”

Compton Lodge operates a keyworker system whereby persons using the service have an identified named worker responsible for their care. Some people using the service knew who their keyworker was, whilst others did not.

Staff are helpful and cheerful and the care delivered is very good. When people need to see a doctor for medical reasons, this is facilitated by the staff. People using the service feel comfortable to report any concerns to the home manager, should this be necessary.

Medication is given to people using the service on time and as prescribed.