Background to this inspection
Updated
12 August 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by three inspectors.
Service and service type
Throwleigh Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
The first inspection day was unannounced. The provider was given 24 hours’ notice of the second inspection day because we wanted to make sure managers were available to speak with us.
What we did before the inspection
We reviewed all information we had received about the service since the last inspection. This included the feedback received from our partner agencies, complaints and statutory notifications that had been submitted since the last inspection. Notifications are changes, events and incidents that the service must inform us about.
As a condition of the provider’s registration that was imposed following our last inspection, we required them to submit a monthly update regarding the progress they had made towards improving the service in specified areas. We have also had regular online meetings with the new registered manager as part of our ongoing monitoring of the service. We used all the information shared within these updates and meetings to help us to plan this inspection.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection
Two inspectors visited the service unannounced on the first inspection day. We met with each of the 13 people who lived at the service and observed the support they received. We spoke with eight members of staff, including the registered manager and regional manager. We reviewed a range of records. These included the care plans for two people and documents relating to medicines. We looked at the recruitment information for three staff.
Following the first inspection visit, the lead inspector was given remote access to the service’s online system and reviewed a range of care records for all the other people living at the service. A variety of records relating to the management of the service, including incidents and accidents and audits were also viewed remotely.
A third inspector made telephone calls to the family members of six people who lived at Throwleigh Lodge. We also spoke with three external professionals who had regular involvement with the service.
A range of serious concerns were identified by our remote reviewing of information and the negative feedback we received from some relatives. We sought some immediate assurances from the provider and the lead inspector returned to Throwleigh Lodge for a second visit. During the second inspection day, we went around t
Updated
12 August 2021
About the service
Throwleigh Lodge is a care home providing support to up to 17 adults with learning disabilities, mental health support needs and complex healthcare needs which require support from trained nurses. At the time of our inspection 13 people were living at the service. The service provided bedrooms and communal areas over the ground floor and first floor of an adapted building.
People’s experience of using this service and what we found
Despite provider assurances that the service had made improvements we found that this was not reflective of people’s experiences. Concerns raised during the inspection have led to ongoing safeguarding investigations and urgent actions taken by the provider to keep people safe.
There was an absence of strong leadership to effectively coach and constructively challenge staff practices. This coupled with the heavy reliance on agency nurses and care staff meant that staff did not have the necessary skills and experience to deliver support in line with best practice.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right support:
• People were not supported to have maximum choice and control of their lives. Staff did not support them in the least restrictive way possible and in their best interests.
• Staff were not deployed in a way that enabled personalised and effective support.
• The continued breakdown in effective relationships and communication across all aspects of the service meant support did not always meet people’s needs.
• Despite some well-meaning and caring members of staff, the running of the service did not support a culture of compassionate support.
Right care:
• People experienced delays in receiving care which subsequently left them at risk of harm.
• Support was task focused with an emphasis on managing people as a collective rather than enabling them to lead individual and meaningful lives.
• People had limited access to activities that developed their skills and independence.
• People were not always treated with privacy and dignity and this impacted on their basic human rights.
Right culture:
•The service lacked a positive culture and people were not at the heart of the service they received.
• There was a lack of accountability for mistakes that had been made, with a focus on blame rather than reflection and improvement.
• Provider oversight was reactive, and improvements were dependent on external pressure and support.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was Inadequate (published 23 February 2021). That was following a targeted inspection that focused on the Safe, Responsive and Well-led domains where we found multiple breaches of regulations. Following that inspection, we imposed a condition on the provider’s registration which required them to complete an action plan and submit monthly evidence of the improvements that had been made. At this inspection, we identified that the service had not improved in the way we had been informed it had, and the provider was still in breach of regulations.
This service has been in Special Measures since February 2021.
Why we inspected
This was a planned inspection based on the previous rating.
We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Enforcement
We identified multiple breaches in relation to the safety of the care people receive, staff deployment, safeguarding, person-centred care and the management of the service at this inspection. We met with the provider immediately after the inspection and in response to our inspection feedback, they made the voluntary decision to close the service.
Since our inspection we have worked closely with the provider and local authority to ensure people received safe care as they were supported to move to new homes.
Follow up
At the time of publication of this report, Throwleigh Lodge has closed and therefore no longer providing a regulated activity. We have accepted the provider’s application to de-register both the registered manager and location and these are now being processed.