The Lodge

The Lodge is a residential care home providing personal care for seven younger adults with learning disabilities and/or autism spectrum disorder. The service can support up to eight people.

The service has been designed taking into account best practice guidance and the principles and values underpinning Registering the Right Support (RRS) in respect of the environment. The building design fitted into the residential area as it was domestic in style in keeping with other homes in the street. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service and what we found

People’s behaviour was not always safely managed, and restraint was not always implemented for the shortest possible time.

There were not always enough staff to safely support people and meet their identified needs.

Staff were not always following current government guidance in relation to COVID19 and the use of personal protective equipment.

People received their medicines when needed and staff where trained to administer people’s medicines safely.

A lack of oversight meant potential risks to people’s safety had not been responded to appropriately. Systems to monitor the quality and safety of the service were not always effective and had not identified the areas for improvement found at this inspection.

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 Good. (Published 30 January 2020).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding, use of restraint and the care being provided. Additional concerns were shared with us by the Clinical Commissioning team and Sandwell Local Authority. A decision was made for us to inspect and examine those risks.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Lodge on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to person centred care, safeguarding, recruitment practices and governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Lodge is a residential care home providing personal care for seven younger adults with learning disabilities and/or autism spectrum disorder. The service can support up to eight people.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

A number of management changes had taken place during the year and a new manager had recently been appointed. Relatives were disappointed they had not been kept informed of these management changes but welcomed the arrival of the new manager. Staff were complimentary of the support provided by the new manager and were positive about the support they received from their colleagues. Additional quality assurance systems had been introduced to provide management and the provider with oversight of the service and identify areas for improvement. Action plans were in place and monitored closely to ensure any areas for improvement identified were completed in a timely manner.

People were supported by a group of safely recruited staff who had receiving training and guidance in how to safeguard people from abuse. Staff were aware of the risks to people on a daily basis and were kept informed of any changes in people’s care needs. People received their medicines as prescribed. Accidents and incidents were reported and acted on appropriately and analysed for any trends.

Staff felt supported and well trained and spoke positively of the help and guidance support they received from their colleagues and the management team. New staff benefitted from an induction which included working with more experienced members of staff. People were supported to maintain a healthy diet and had access to drinks and snacks throughout the day. Staff were aware of people’s healthcare needs and assisted people to access a variety of healthcare services.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

We saw staff were kind and caring and had positive relationships with the people they supported. Families were kept informed of their loved one’s care needs and were happy with the care they received. People were treated with dignity and respect by staff who supported them, where possible, to maintain their independence.

Staff knew people well and were aware of what was important to people, their likes and dislikes and how they wished to spend their time. People were encouraged to participate in activities that were of interest to them, both in the home and the community. People were confident if they had any concerns, they would be responded to appropriately. People’s views were regularly sought to ensure they were happy with the care and support they received.

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 requires improvement (published 10 January 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We undertook an unannounced focused inspection of The Lodge on 07 December 2018. We inspected the service against two of the five questions we ask about services: is the service safe? and is the service well led? This was because information of concern had been bought to our attention regarding the service.

The 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 Lodge accommodates eight people with a learning disability in one adapted building. At the time of the inspection there were eight people living at the service. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager, but they were not present during the inspection and had recently submitted their application to de-register as the registered manager of the service. 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 appeared comfortable in the company of the staff who supported them and regularly approached them for reassurance and support. Staff now felt confident that they would be listened to if they raised concerns and that management would act on those concerns appropriately.

People were supported by sufficient numbers of safely recruited staff. Staff were aware of the risks to people and how to support them safely but audits in place had failed to identify where information had not been updated in some care records.

People received their medicines as prescribed but ‘as required’ protocols in place for some people were incorrect and did not provide staff with the information they required in order to administer the medication safely and effectively.

Concerns regarding the reporting and recording of accidents and incidents were being looked into and analysis was taking place to ensure lessons were learnt when things went wrong.

Management acknowledged they had failed to respond appropriately and provide the relevant support to staff when six staff had been dismissed.

A number of whistle-blowing concerns had prompted management to act swiftly and meet with all staff. Plans were in place to address the concerns raised by whistle-blowers and additional support was being provided to all staff.

Staff felt supported and listened to and were confident that management would act on issues raised.

The 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 Lodge accommodates eight people in one adapted building. At the time of the inspection there were eight people living at the service. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager. 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.’

Systems were in place to ensure people were supported by staff who had received training in how to recognise signs of abuse. Staff were aware of what actions they should take if they suspected a person was at risk of harm. Where safeguarding concerns arose, they were responded to appropriately.

Staff were aware of the risks to people and how best to support them. Behaviour management plans in place provided staff with information on how to support people safely and in line with their specific needs.

Safe systems of recruitment were in place. The skill mix of staff on each shift ensured the appropriate support was available to people on a daily basis. Systems were in place to ensure people received their medicines as prescribed by their GP and staff competencies in this area were checked.

Systems were in place to protect people from the spread of infection. Accidents and incidents were reported, recorded and investigated and where appropriate lessons were learnt.

Care records provided staff with the information required to effectively support people’s care, health and social well-being. Staff were supported by the management team through regular supervisions, training and team meetings. Systems were in place to monitor staff learning and ensure that staff put into practice the training that was provided.

People were supported to visit their GP and other healthcare professionals, in order to maintain good health. People were involved in planning their weekly menus and where possible, encouraged to be involved in the preparation of their food and drinks.

Staff obtained people’s consent prior to offering support. 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.

People receive support from caring staff who treated them with dignity and respect. People were comfortable in the presence of staff, who provided them with comfort and reassurance. People were provided with information in a format they understood.

People were supported to contribute to the planning of their care. Staff supported people in a way that took account of their individual needs and preferences.

Where complaints were raised, they were investigated and responded to accordingly and where appropriate, lessons were learned. People were confident that if they did raise concerns they would be listened to and action would be taken.

The service was considered to be well led. People, relatives and staff spoke positively of the changes in management and practice. Staff were motivated and felt supported by in their role and were on board with the registered manager’s vision for the service.

People and staff were provided with the opportunity to give feedback on the service, which was then acted upon. A variety of audits were in place to assist the registered manager in driving improvement across the service.

The registered manager and staff group worked alongside other agencies in order to obtain the appropriate care and support for people.

Records showed that people were involved in their care planning and they consented to the care and support they received. We observed that staff asked people for their opinion, and this was respected.

We saw that staff delivered appropriate care and support for people throughout the day. People we spoke with told us that staff looked after them.

We found robust systems in place for the management of medicines. Arrangements were in place to ensure that people received their medicines as prescribed.

Selection and recruitment processes were robust to ensure that appropriate staff were employed to look after people at the home. We asked one person whether the staff were nice. They said, 'Yes.'

People were aware of how to complain if they were unhappy with the service. We saw the complaints process displayed in a communal area which people could access.

We saw that people were involved in making choices about what they wanted to do and what they ate and drank. One person told us they went out for a walk and nice drink.

We found that people's needs were appropriately assessed and planned to ensure that the care people received was safe and appropriate. All of the people we spoke with told us they were happy with the care they received. One person told us, "It's lovely here at the Lodge, everyone is friendly and positive'.

We found that people's care records provided an overview of people's needs and preferences. We found that people were involved in their care planning and a range of different activities. So that they were supported to do the things that were important to them. One person told us, "I do my care plan'.

Staff knew how to safeguard people from harm and felt confident that if they had to report any abuse, action would be taken to protect people.

We saw that people's health and welfare needs were met by competent staff that had appropriate checks, supervision, training and appraisal.

There was a system to monitor the quality of service people received through regular reviews and audits.