Faro Lodge

Faro Lodge is a care home providing respite care for up to six people who have a learning disability. On the day of our inspection, one person was at the service.

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

Risk assessments were not always in place. One person’s care plan described risks of leaving the service without staff knowing. No detailed risk assessments had been created to mitigate risk. This person had left the service unsupported during their stay. This placed them in danger.

The provider supported many people who used the service for short stays, periodically throughout the year. The provider had not assessed the mental capacity of any person using the service and had instead completed a Best Interest Decision and Deprivation of Liberty authorisation request. This is not in line with the principles of the Mental Capacity Act 2005.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Communication between the staff and the person supported on the day of the inspection was positive and the person appeared well engaged. Care plans lacked sufficient detail on how to communicate with people, causing a risk that the support may not be consistent.

At this inspection we found the same areas we had highlighted in our previous inspection, evidencing a lack of progress had been made following our last inspection. In addition, other areas appear to of now deteriorated and additional breaches of regulation have now been identified.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was requires improvement (published 13 March 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This inspection was prompted in part due to concerns received about a person leaving the service unsupported. A decision was made for us to complete a comprehensive inspection following this.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 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 people being kept safe when being supported, people’s mental capacity being assessed and the provider’s response to previous inspections that have not enabled lessons to be learnt within the service.

Please see the action we have told the provider to take at the end of this report.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. 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.

Faro Lodge is a care home providing respite care for up to six people who have a learning disability. On the day of our inspection, two people were using the service.

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

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; however, the policies and systems in the service did not always support this practice.

The provider supported many people who used the service for short stays, periodically throughout the year. Appropriate Deprivation of Liberty Safeguards (DoLs) were not always sought, to ensure people were not unlawfully restricted. Mental capacity assessments were not always detailed to show how a decision had been made about a person’s capacity.

Care planning documents were not always sufficiently detailed. One person’s care plan contained information from an old care provider. The service had not created their own detailed care plan for this person.

Risk assessments were not always in place. We saw one person’s care plan describe risks of leaving the service without staff knowing, epilepsy, and risk to the person around personal relationships. No detailed risk assessments had been created to mitigate these risks.

Audits and quality monitoring within the service had not identified the lack of care planning, risk assessment, and DoLs applications.

Safe recruitment procedures ensured that appropriate pre-employment checks were carried out, and staffing support matched the level of assessed needs within the service during our inspection.

Medicines were stored and administered safely, staff were trained to support people effectively and were supervised well and felt confident in their roles. People were able to choose the food and drink they wanted, and staff encouraged healthy options. Cultural requirements with food and drink were understood and respected by staff.

Healthcare needs were met, and people had regular access to health and social care professionals as required.

Staff treated people with kindness, dignity and respect and spent time getting to know them. Care was personalised to each individual, and staff were passionate about supporting people to achieve independence where they could, and live full lives.

People and their family were involved in their own care planning as much as was possible. A complaints system was in place and was used effectively.

The management team was open and honest, and worked in partnership with outside agencies to improve people’s support when required.

The service did not have a registered manager in place, but were recruiting for the role. Staff felt positive about their roles and were well supported by the wider management team.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 26 April 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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 Faro Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to regulation 11 (need for consent). This is because of continued failures to appropriately apply for deprivation of liberty safeguards.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. 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 home has had the current registered manager in post since November 2013. 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.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. People were able to leave the home when this wished, although assessments had not been made to determine if formal DoLS applications needed to be made. Where someone lacked capacity to make their own decisions, mental capacity formal assessments had not been completed, although information was available in care records.

Staff were aware of safeguarding people from the risk of abuse and they knew how to report concerns to the relevant agencies. They assessed individual risks to people and took action to reduce or remove them. There was adequate servicing and maintenance checks to fire equipment and systems in the home to ensure people’s safety.

People were safe staying at the home and staff supported them in a way that they preferred. There were enough staff available to meet people’s needs and the registered manager took action to obtain additional staff when there were sudden shortages. Recruitment checks for new staff members had been made before new staff members started work to make sure they were safe to work within care.

People received their medicines when they needed them, and staff members who administered medicines had been trained to do this safely. Staff members received other training, which provided them with the skills and knowledge to carry out their roles. Staff received adequate support from the registered manager and senior staff, which they found helpful.

People were able to choose what they ate and drank, and staff knew what people’s individual dietary preferences were. They received enough food and drink to meet their needs. Staff members had information about health professionals so that people could receive advice and treatment quickly if needed.

People and visitors were highly complimentary about how staff cared for people. Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. They responded to people’s needs well and support was always available. Care plans contained enough information to support individual people with their needs. People liked going to stay at the home and staff supported them to be as independent as possible.

A complaints procedure was available and people knew how to and who to go to, to make a complaint. The registered manager was supportive and approachable, and people or other staff members could speak with them at any time.

Good leadership was in place and the registered manager and provider monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible and to improve the quality of the care provided.

All four relatives of people using the service we spoke with were also complimentary about the service. A relative told us that, "The staff and environment (at Faro Lodge) are brilliant.' They went on to tell us that they were kept informed of what was happening to their family member by the provider as communication was, 'Good.'

We looked at three people's care records and found that they contained detailed information and guidance to enable staff to deliver individual, safe care and support.

When reviewing medication administration records (MAR) charts, we saw documented evidence of accurate medication administration by staff members.

Effective staff recruitment was in place to make sure that people using the service received safe care and support from suitable and knowledgeable staff.

There was an effective system in place for people using the service, their relatives and visitors to raise a concern or complaint if they wished to do so.