St Lawrences Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. St Lawrences Lodge is registered to provide accommodation and personal care for 16 people. It is not registered to provide nursing care.

The service was last inspected in November 2017 and at the time the service was rated as good in all domains.

This inspection was prompted in part because CQC had received a copy of a Regulation 28 Report (Prevention of future deaths report) issued to the provider from the Coroner. Regulation 28 Reports (R28 Reports) are issued by Coroners when the Coroner remains concerned that, despite evidence given at an inquest by witnesses including the registered provider, similar incidents could reoccur. In response the provider had taken action to increase CCTV within the home to improve staff oversight within communal areas and reduce the risk of falls.

At this inspection the overall rating of the service is requires improvement. This was because we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found a breach of regulation 17 (good governance) because the service did not have sufficiently robust governance systems to have identified the concerns we found at inspection and address a specific risk identified at a recent inquest. These related to the management of risks, the recording of time sensitive medicines and allergies and meeting the requirement for sending statutory notifications to the CQC.

The service had policies in place but we found these did not always reflect current legislation or contain sufficient guidance for staff.

People were positive about the registered manager and the way the home was organised and managed. Staff told us they enjoyed working at the home and felt supported.

Recruitment procedures were in place which ensured staff were safely recruited. Staff received the training, support and supervision they needed to carry out their roles effectively.

People’s independence was promoted, they had choices and were treated with dignity and respect by staff.

People were supported by caring staff who knew them and their care needs well. We observed genuine affection and kind and caring interactions between people and staff.

People had their nutritional needs met and had access to a range of health care professionals.

The requirements of the Mental Capacity Act 2005 were being met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Health and safety checks were carried out and equipment was maintained and serviced appropriately.

Activities were available for people to access within the home and individual interests were encouraged. People were supported to engage in these activities.

The home was clean and there was a relaxed and homely atmosphere.

The service had a complaints procedure and a variety of ways for people, visitors, and health care professionals to share their views and provide feedback on the service. The manager used this information to drive improvements within the service, such as increasing the number of activities for people to engage with.

The registered manager had oversight of accidents, incidents, safeguarding and complaints and this information was analysed for themes and patterns. We saw that action such as referring to appropriate services for additional assessment and support were completed. We spoke to the registered manager about ensuring the documentation reflects the work that is undertaken in order to improve the systems of governance with the home.

Statutory notifications were not always being sent to the CQC as required.

The ratings from

This inspection took place on 13 and 14 November 2017 and was unannounced.

At our previous inspection on 17 August 2016 the service was given an overall rating of requires improvement and we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment, need for consent, person-centred care and good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, by when to improve the overall rating of the service to at least good. At this inspection we found the provider had taken the required action necessary and was now meeting the regulatory requirements.

St Lawrence's Lodge provides care for older people, some of whom are living with a diagnosis of dementia or experience short term memory loss. The home is situated in a residential area, close to the centre of Denton, Manchester.

St Lawrence’s 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.

The care home is registered with CQC to provide care and accommodation for up to 20 people. However, as a result of home refurbishments undertaken there were now a maximum of 16 single occupancy rooms in one adapted building serviced by a lift to the second floor. At the time of the inspection, 16 people were using the service.

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.

People living at St Lawrence’s Lodge told us they felt safe and said staff were kind and caring. The staff we spoke with told us they had completed training in safeguarding and were able to describe the different types of abuse.

There were policies and procedures to guide staff about how to safeguard people from the risk of abuse or harm. Staff had access to a wide range of policies and procedures regarding all aspects of the service.

Staff received appropriate induction, training, supervision and appraisal and there was a staff training matrix in place. Staff told us they had sufficient induction and training and this enabled them to feel confident when supporting people.

We saw there were individualised risk assessments in place to identify specific areas of concern. The care plans were person-centred and covered essential elements of people’s needs and preferences. Staff sought consent from people before providing support. People’s health needs were managed effectively and there was evidence of professional’s involvement.

Equipment used by the home was maintained and serviced at regular intervals. The home was clean throughout and there were no malodours. The environment was suitable for people's needs.

We looked at five staff personnel files and there was evidence of robust recruitment procedures.

Accidents and incidents were recorded and audited monthly to identify any trends or re-occurrences. The home had been responsive in referring people to other services when there were concerns about their health.

People told us the food at the home was good. There was a four week seasonal menu in use and this was displayed on the wall in the dining room. We found people's nutritional needs were monitored and met.

People who used the service told us staff treated them well and respected their privacy and dignity. We observed positive interactions between staff and people who used the service.

The service aimed to embed equality and human rights though good person-centred care planning and people were provided with a range of useful infor

This inspection took place on 17 August 2016 and was unannounced. A previous inspection, undertaken in June 2014, found there were no breaches of legal requirements.

St Lawrence’s Lodge is registered to provide care and accommodation for up to 20 people. However, we noted that due to the upgrading of accommodation there were now a maximum of 16 single rooms for use at the home. The home provides care for older people some of whom are living with dementia or short term memory loss. The home is situated in a residential area, close to the centre of Denton, Manchester.

The home had a registered manager in place and our records showed she had been formally registered with the Care Quality Commission (CQC) since April 2014. A registered manager is a person who has registered with the CQC 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 said they felt safe living at the home and said the staff treated them well. Staff had received training regarding safeguarding and the protection of vulnerable adults. They said they would report any concerns to the registered manager. We found a number of issues with infection control and safety at the premises. The laundry area was small and cramped and inappropriate facilities were available to deal with the cleaning of commodes.

Discarded equipment had been left in a yard at the rear of the home, which could be accessed by people living there. People did not have personal evacuation plans in place in the event of a fire or other emergency.

Suitable recruitment procedures and checks were undertaken, to ensure staff had the skills and experience to support people. People said they received appropriate care and thought there were sufficient staff to meet their needs.

Medicines were not always dealt with safely and appropriately. Some dates were over written making it unclear when medicines had been given and “as required” medicines did not have detailed care plans for their administration. Checks on the temperature of the clinical room, where medicines were stored, were not made daily.

People were happy with the standard of food and drink provided at the home and could request alternative dishes, if they wished. People who required alternative diets were supported.

People told us staff had the right skills to look after them. Staff confirmed they had access to a range of training and updating. Regular supervision took place, although formal annual appraisals did not occur.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The manager told us no one at the home was subject to DoLS. However, we observed some people who may fit the criteria for a DoLS application. Best interest decisions processes were not consistently applied.

People’s health and wellbeing was monitored, with regular access to general practitioners and other specialist health or social care staff.

People told us they were happy with the care provided. We observed staff treated people appropriately, supportively and with a good understanding of them as individuals. People said they were treated with respect and their dignity maintained during the provision of personal care. Security cameras were in use at the home, but people had not been asked explicitly if they were happy for them to be in place.

Care plans reflected people’s individual needs, although details in care plans were not always specific enough to ensure staff could provide care safely and consistently. Reviews of care occurred regularly but were often lacking in detail. All staff supported people in engaging in activities. There had been no recent formal co

During our inspection we spoke with the registered manager, care staff on duty and the cook. We also spoke with three people who lived at St Lawrence’s Lodge and two regular visitors to the home. We took a tour of the building and spent some time observing the interactions between staff and the people who lived at St Lawrence’s Lodge. We looked at a selection of the provider’s records, including a sample of people’s care records.

This inspection was undertaken by one inspector. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive; and is the service well led?

The full report contains the evidence to support this summary.

Is the service safe?

We saw that people were treated with dignity and respect by staff. We spoke with several people who lived at St Lawrence’s Lodge, whose comments included: "The staff are very kind and helpful and I feel very safe living here”, “It’s lovely here – I can’t grumble – good staff, good food and a nice bedroom” and “I have no worries or concerns – this is my home and I wouldn’t want to live anywhere else. Yes, I do feel safe living here”. We also spoke with two regular visitors to the service, who told us they had no concerns about the care being provided to their relatives who lived in the home.

Equipment was well maintained and serviced regularly therefore not putting people at unnecessary risk.

The registered manager sets the staff rotas, they take people’s care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helps to ensure that people’s needs are always met.

Is the service effective?

People’s health and care needs were assessed with them, and wherever possible, they were involved in writing and developing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

There were effective systems in place to assess, monitor and regularly evaluate how well the service was operating. Information was available to demonstrate that regular reviews of care plans and peoples assessed needs were carried out. This meant that the management team could make changes to people’s support needs quickly and effectively.

Everyone we spoke with was positive about the service and support provided. Comments included “I can come out here (garden) and have a smoke – it’s really good”. “I am looked after very well and I like it here”, “you never have to look for the staff, they are always around – ready to help” and “It’s a lovely place to live”.

Is the service caring?

Throughout our visit to the service we saw staff treat people kindly, with respect and allow people time to be as independent as they could be. Careful consideration had been given to people’s likes and dislikes and this was respected during daily routines. This was supported by the positive views expressed by the people using the service and their visitors.

Is the service responsive?

A quality monitoring system was in place. The manager told us that such systems helped to identify areas of concern, good practice and potential areas for further development and improvement.

The registered manager confirmed that there was no contingency plan in place to deal with emergencies such as gas leaks, flooding, evacuation of the premises and water supply. The provider may wish to consider developing such a plan to ensure all staff have relevant guidance available to them should such circumstances occur.

Is the service well led?

The manager and staff told us that the service worked well with other agencies such as the district nurses and general practitioner services to make sure people received their care in a joined up way.

Staff told us they were clear about their roles and responsibilities. Staff were able to tell us what the ethos of the home was and how the quality assurance processes carried out by the manager helped to make sure people received a good quality service at all times.

We spoke with people who lived at St Lawrences Lodge about their care and treatment. We observed that a number of people who lived at the home were unable to comment in detail about the care they received due to memory impairment. As a consequence of this we found that some people were unable to communicate their feelings about the care they received. In light of this we spoke with care staff and spent a lot of time observing routines at the home and staff interaction with people. We spoke with one relative of a person who lived and the home and we spoke with an advocate of another person who lived at St Lawrences Lodge.

One person said: “I am very happy and quite satisfied with the care I receive.”

One visitor told us: “Care is great…staff are very caring and respectful towards [resident], staff work hard and are good with the residents.”

Another visitor said: “We feel relaxed knowing that [resident] is getting the attention she deserves.”

We found that staff made every effort to include people in decisions about how their care was delivered.

We found that the registered provider operated an effective recruitment and selection process and this ensured that good quality staff were recruited to work at the home.

We saw that there was an effective system in place that assessed and monitored the quality of service provided to people who lived at the home.

We visited the service on the 4 December 2012 to follow up on the compliance actions we made following a visit to the service in June 2012.

In June 2012 we had concerns that people living at St Lawrences Lodge were not receiving their prescribed medications. We were also concerned about the way people’s personal records were stored.

On the 4 December 2012 people told us they were happy with their care. They told us they got their medication. Relatives told us they were happy with the care provided and one person said they had, “… no concerns whatsoever”. Another relative told us, “Care is good”. One person said, “I’m very well looked after”.

Even though people were content with the care we found people were not receiving their medication as prescribed. We found evidence that one person had not been given their breakfast time medication on the day of our visit, 4 December 2012.

We found hand written medication administration records were still not being completed correctly.

We found evidence of three separate occasions where the home had run out of people’s medication.

We found peoples personal care plans and other records were now securely stored in a locked area of the building to which only staff had access to. We found that since our last inspection the registered provider had purchased lockable cupboards for the office and other records were securely stored.

People told us they were cared for and staff were nice.

They told us they liked their bedrooms and they enjoyed the food provided.

Relatives told us they had looked at other care homes but they liked St Lawrences Lodge because it was clean and care staff were very friendly and welcoming.

One relative who visits daily told us the home was always clean and free from odours.

Relatives told us there was always enough staff on duty when they visited St Lawrences and that they visited in the evenings and at weekends.

One relative said, “My mother is well looked after.”

Another relative said of the home, “They provide the best care possible.”

Relatives we spoke with were very positive about the care provided. All said that the home consulted them about important aspects of their relatives care needs.

Other relative feedback included the following;

“I can’t fault it.”

“It’s been excellent”

“I’m always made welcome.”

They told us they could talk to staff at anytime and never had cause to make a complaint. They told us that the manager was very approachable and easy to talk to.

We undertook an inspection of the home on the 19 March and 20 March 2013 in response to information of concern.

One person told us; “The staff are lovely, they are so helpful nothing is too much trouble”.

One visitor told us; “They [care staff] are very good at getting the GP to visit when my mum is poorly”. We found that care staff worked with other professionals to ensure a coordinated response to meet people’s health and social care needs.

During our visit we observed that people living at the home were treated with dignity and consideration by staff at all times. We observed that people appeared relaxed and confident around staff and comfortable in their presence. However we were concerned to find that the provider did not notify us straight away of safeguarding incidents.

We were concerned to find that care plans and risk assessments were not routinely updated following changes or deterioration in a person’s care needs. This was because the provider did not have an effective system in place that regularly assessed and monitored the quality of service that people received, which picked up changes in people’s care needs.

We found that the home was clean and hygienic and equipment to assist people in mobilising was available and in good working order.