In September and October 2019 we carried out enter and view visits at three local care homes run by Excelcare, following a quality and safety review by Lambeth Council which indicated improvement was needed:
- Queens Oak Care Centre, Southwark
- Windmill Lodge Care Centre, Lambeth
- Limetree Care Centre, Lambeth
The council has a block contract with Excelcare which provides most of its funded places for Lambeth residents at the three homes. Our visits aimed to assess the homes’ progress since the council’s review and to look at three particular Healthwatch concerns: loneliness, oral health and advance care planning.
During the visits, our enter and view team spoke to residents, family members and staff and we also sent surveys to all staff and family contacts. We recorded episodes of staff and resident interactions and used a checklist to observe communal areas based on NHS dementia friendly environment criteria.
Take a look at the full report, or read a summary of our findings and recommendations below.
Overall, we found that considerable progress had been made in all three homes against their improvement plans. Across the homes, we found a general sense of commitment from staff and management to provide satisfactory and safe experiences for residents.
Some good practices were identified including examples of sensitive, person-centred care, activities to address isolation, introduction of better meals, and presence of advance care planning for some.
However, we also found that the care and safety experience of residents varied within the homes, which appeared to be due to uneven staff skills and stretched capacity. This mixed picture was reflected in the family feedback we received. While some family members were content with their loved one’s care, a few relatives expressed strong concerns and felt that they had not been engaged well by the home or regularly updated.
Our recommendations address these points and we will be discussing them with the provider and the council to explore next steps for the homes.
Summary of findings by centre
Queens Oak Care Centre
Overall the visit team found that the centre was an attractive facility with dementia friendly decor, except for one floor which was due to be refurbished. The residents seemed comfortable and relaxed, and the atmosphere appeared cheerful. Our team observed friendly and respectful interactions between staff and residents. The working culture was positive overall. However there were some notable capacity pinch points surrounding mealtimes and contact time with residents and a need to better address ways for tracking changes in wellbeing and finding lost personal items.
The recommendations for the centre focus on making notice boards easier to read for both residents and staff, ensuring menus are up to date, and assisting residents with oral care. We also recommend that the centre includes end of life care in conversations with residents’ families, as well as making sure all staff are trained consistently.
Windmill Lodge Care Centre
The feedback, interviews and visit experience painted a mixed picture of this home. The visit team’s overall impression was that the home has a welcoming and driven staff committed to seeing through planned improvements. We saw good care but also some instances of inattentive staffing. Feedback from families of residents was varied, as some said they were very content with the care provided, but others felt there was inadequate levels of support. There may be issues of understaffing and current staff may require training to be more responsive to resident needs.
Our recommendations include the creation of an alternative staff smoking area further away from resident facilities, better staff training on core skills like communication with family members and including family members in conversations regarding oral care. We suggest the home should also consider how to maximise the activities programme by empowering all staff present to support it, and by diversifying the range of activities for residents.
Limetree Care Centre
This centre was well laid out and decorated in a dementia friendly way. The facility appeared clean and had a particularly pleasant garden. Our team found staffing to be generous and largely person-centred on the day of the enter and view, though feedback from some family members said it can seem stretched at times. Family feedback indicated that this can affect the home’s ability to provide adequate care including maintaining residents’ personal hygiene and keeping track of personal possessions.
Recommendations include finding ways to safeguard residents’ personal items, the improvement of staff skills to deliver more consistent care, and improving communication with families to better include them in activities and care, as well as reviewing the activities programme itself to offer more diversity and support better take up amongst residents.