CQC
Regulator / Inspectorate
Action Planned
The CQC requested information from the provider regarding their actions following the death and any additional actions planned. CQC plans to complete an assessment within the new Single Assessment Framework, focusing on relevant Quality Statements, within the next 3 months. (AI summary)
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Dear Mr. Hobson,
Thank you for sending CQC a copy of the prevention of future death report issued following the death of Blanche Audrey Knowles.
CQC has contacted the provider HC-One No.1 Limited, Colton Lodges Care Home, to request written confirmation and evidence of the action they have taken to date following this death and any additional action they intend to take in response to the prevention of future death report.
We note the legal requirement upon the following individuals and organisations to respond to your report within 56 days:
1 The registered manager, Whitkirk House, Colton Loges Care Home, 2 Northwood Garden, Colton Lodges, Leeds
2. HC-One Healthcare company
3. Care Quality Commission
We are responding as directed.
Having received your report, the CQC took steps to request information and seek assurance from the provider regarding the concerns within the report.
CQC have requested the following information and documents from the provider:
1. First aid policy updated. Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA
2. Assurances and evidence that all staff have been made aware of the updated policy and appropriately trained to implement it.
3. Assurances and evidence if there have been any incidents of burns in the last 12 months, actions taken and outcome.
4. Assurances and evidence of any lessons learns, or other actions you have taken since Mrs Knowles’s death to ensure people living at Colton Lodges are safe.
In additional, we have requested, received and reviewed the following documents:
1) Mrs. Knowles’ mental capacity assessment for the decision to live at Colton Lodges Care home, and receive care and treatment as required, dated 12/12/22.
2) Mrs. Knowles’ safer handling risk assessment and care plan dated 13/12/22.
3) Mrs. Knowles’ eating and drinking care plan dated 16/07/23 and monthly reviews completed.
4) Mrs. Knowles’ diet and fluid notification form completed on 04/08/23 and reviewed 04/11/23.
5) Mrs. Knowles’ communication care and support plan dated 11/12/22.
6) Mrs. Knowles’ eating and drinking risk assessment dated 23/12/22.
7) Mrs. Knowles’ care records, professional records between 10/11/22 and 29/8/23.
8) Mrs. Knowles’ drinking hot boiled water/aired water 18/07/23.
9) Mrs. Knowles’ daily notes between 01/08/23 and 01/09/23.
Since Colton Lodges Care Home registration, CQC have discharged its regulatory function through ongoing review of enquiries and notifications, direct monitoring activity and inspections.
For ease we will set out all the inspections undertaken since registration.
• Inspection completed on 17 and 18 July 2018, overall rating Requires Improvement, breach in regulation 19 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Link to inspection report: 4286bbc7-2eab-4125-90f0-6d5530f8a6fb (cqc.org.uk)
• Inspection completed on 5 and 13 March 2020, overall rating Requires Improvement, breaches in regulations 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Link to inspection report: 86dc7ae6-0c9d-4885- b7ba-ae0d20b7193a (cqc.org.uk)
• Inspection completed on 4 and 10 May 2023, overall rating Requires Improvement. Link to inspection report: bdc41bc8-6fa5-46ff-a1a5- 20db3732221a (cqc.org.uk)
CQC note the concerns outlined in section 5 of the Regulation 28 report.
Action CQC intends to take is to complete an assessment within the new Single Assessment Framework, focusing on the relevant Quality Statements, within the next 3 months.
If CQC deems insufficient progress has been made by the Trust or if there is risk to service users, CQC will consider discharging its regulatory functions.
Thank you in advance for your assistance.
Thank you for sending CQC a copy of the prevention of future death report issued following the death of Blanche Audrey Knowles.
CQC has contacted the provider HC-One No.1 Limited, Colton Lodges Care Home, to request written confirmation and evidence of the action they have taken to date following this death and any additional action they intend to take in response to the prevention of future death report.
We note the legal requirement upon the following individuals and organisations to respond to your report within 56 days:
1 The registered manager, Whitkirk House, Colton Loges Care Home, 2 Northwood Garden, Colton Lodges, Leeds
2. HC-One Healthcare company
3. Care Quality Commission
We are responding as directed.
Having received your report, the CQC took steps to request information and seek assurance from the provider regarding the concerns within the report.
CQC have requested the following information and documents from the provider:
1. First aid policy updated. Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA
2. Assurances and evidence that all staff have been made aware of the updated policy and appropriately trained to implement it.
3. Assurances and evidence if there have been any incidents of burns in the last 12 months, actions taken and outcome.
4. Assurances and evidence of any lessons learns, or other actions you have taken since Mrs Knowles’s death to ensure people living at Colton Lodges are safe.
In additional, we have requested, received and reviewed the following documents:
1) Mrs. Knowles’ mental capacity assessment for the decision to live at Colton Lodges Care home, and receive care and treatment as required, dated 12/12/22.
2) Mrs. Knowles’ safer handling risk assessment and care plan dated 13/12/22.
3) Mrs. Knowles’ eating and drinking care plan dated 16/07/23 and monthly reviews completed.
4) Mrs. Knowles’ diet and fluid notification form completed on 04/08/23 and reviewed 04/11/23.
5) Mrs. Knowles’ communication care and support plan dated 11/12/22.
6) Mrs. Knowles’ eating and drinking risk assessment dated 23/12/22.
7) Mrs. Knowles’ care records, professional records between 10/11/22 and 29/8/23.
8) Mrs. Knowles’ drinking hot boiled water/aired water 18/07/23.
9) Mrs. Knowles’ daily notes between 01/08/23 and 01/09/23.
Since Colton Lodges Care Home registration, CQC have discharged its regulatory function through ongoing review of enquiries and notifications, direct monitoring activity and inspections.
For ease we will set out all the inspections undertaken since registration.
• Inspection completed on 17 and 18 July 2018, overall rating Requires Improvement, breach in regulation 19 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Link to inspection report: 4286bbc7-2eab-4125-90f0-6d5530f8a6fb (cqc.org.uk)
• Inspection completed on 5 and 13 March 2020, overall rating Requires Improvement, breaches in regulations 12 (Safe care and treatment) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Link to inspection report: 86dc7ae6-0c9d-4885- b7ba-ae0d20b7193a (cqc.org.uk)
• Inspection completed on 4 and 10 May 2023, overall rating Requires Improvement. Link to inspection report: bdc41bc8-6fa5-46ff-a1a5- 20db3732221a (cqc.org.uk)
CQC note the concerns outlined in section 5 of the Regulation 28 report.
Action CQC intends to take is to complete an assessment within the new Single Assessment Framework, focusing on the relevant Quality Statements, within the next 3 months.
If CQC deems insufficient progress has been made by the Trust or if there is risk to service users, CQC will consider discharging its regulatory functions.
Thank you in advance for your assistance.