Lotus Lodge

Lotus Lodge is a residential care home providing the regulated activity of accommodation and personal care to up to 7 adults with learning disabilities and on the autistic spectrum. At the time of our inspection there was 1 person using the service.

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

Relatives we spoke with expressed satisfaction with the service and told us it had improved. One relative said, “I am very happy with it now. I haven’t been in the past, but it is much improved.”

Right Support: People lived in an ordinary residential home in a residential street. They were supported by a staff team that understood their needs.

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.

Right Care: People were protected from the risk of abuse. Risk assessments had been carried out to identify the risks people faced. These included information about how to mitigate those risks. There were enough staff working at the service to meet people's needs and the provider had robust staff recruitment practices in place. Infection control and prevention systems were in place. Accidents and incidents were reviewed to see if any lessons could be learnt from them.

Right Culture: People were supported with care that was person-centred. Quality assurance and monitoring systems were in place to help drive improvements at the service. Relatives and staff told us there was an open and positive culture at the service. The provider was aware of their legal obligations and worked with other agencies to develop best practice and share knowledge.

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

Rating at last inspection and

The last rating for this service was requires improvement (published 10 August 2022). 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

We carried out an unannounced inspection of this service on 28 June 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires improvement t Good. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Lotus Lodge is a residential care home providing personal care to seven people at the time of the inspection. The service can support up to seven people.

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

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

The provider did not have robust staff recruitment procedures in place to help ensure people were safe. Quality assurance and monitoring systems were not always effective. Medicines were not always managed in a safe way and we have made a recommendation about this.

Right Support

People were supported in a safe way that was personalised around their individual needs. People lived in an ordinary home in a residential area. There were enough staff to meet people’s needs. People were supported to take risks in a safe way.

Right Care

People told us they were happy living at the service and with the care they received. Staff understood people’s needs and how to meet them.

Right culture

The culture was an open and inclusive one. People and others were able to express their views. The management was supportive and approachable.

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 26 March 2020) and there were breaches of regulation. 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 some regulations, but was in breach of others.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 11 February 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained Requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to staff recruitment practices and quality assurance monitoring at this inspection. We have also found some concerns with medicines management and have made a recommendation about this.

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

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Lotus Lodge is a residential care home providing accommodation and personal care. At the time of the inspection they were providing care to six people with a learning disability or who were on the autistic spectrum. The service can support up to seven 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. 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

The service was not always safe because medicines were not managed appropriately, and the premises were potentially dangerous. Risks to people were not always properly assessed. Quality assurance systems had failed to identify and address shortfalls within the service. Newly recruited staff did not complete the Care Certificate [a nationally recognised qualification for the care sector] and we have made a recommendation about this.

Systems were in place for responding to allegations of abuse and staff and staff had undertaken training about this. There were enough staff working at the service to meet people's needs. Pre-employment checks had been carried out to help ensure suitable staff were employed.

Pre-admission assessments were carried out to determine people's needs. Staff were supported through training and supervision. People had enough to eat and drink. The service worked with other care agencies to promote and meet people's health care needs. 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.

Staff were friendly and polite in their interactions with people and people told us staff were caring. People were supported to be as independent as possible and the service sought to meet needs around religion and ethnicity.

Care plans were in place which set out how to meet people's needs. People and relatives were involved in developing these. The service sought to meet people's communication needs and to provide information in an accessible format. A variety of social and leisure activities were offered, and people were able to maintain relationships with family and friends. Systems were in place for dealing with complaints.

There was a registered manager in place. People and staff spoke positively about them and about the working culture at the service. The provider worked with other agencies to develop knowledge and share best practice.

The service applied the principles and values 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.

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 requires improvement (published 13 March 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. 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 was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to medicines, the premises and equipment used risk assessments and quality assurance systems at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Lotus 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 service supports adults with learning disabilities and on the autistic spectrum and people with an acquired brain injury. It is registered to provide support to seven people and six people were using the service at the time of our inspection.

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.

The service did not have a registered manager in place. There was an acting manager in place and they told us they were in the process of applying for registration with the Care Quality Commission. 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.

During this inspection we found three breaches of regulations. We found health and safety concerns relating to medicines, infection control and cleanliness and food safety. The service had not carried out assessments of people’s mental capacity and there was no record that decisions made on behalf of people were in their best interests. The service did not operate effective quality assurance and monitoring systems. You can see what action we told the provider to take at the back of the full version of the report.

Systems were in place to help safeguard people from the risk of abuse and staff were aware of their responsibilities for reporting abuse. There were enough staff to meet people’s needs and robust staff recruitment practices were established. Risk assessments were in place setting out how to support people safely.

People’s needs were assessed before they commenced using the service. Staff were supported to develop knowledge and skills through regular training and supervision. People were supported to eat a balanced diet and they told us they enjoyed the food. Where required, the service supported people to access relevant health care professionals.

People told us staff treated them well and that they were caring. We observed staff interacting with people in a caring manner. Steps had been taken to support people in relation to equality and diversity.

Care plans were in place which set out how to meet people’s individual needs and these were subject to review. People had access to a variety of activities. Complaints procedures were in place and people told us they knew who they could complain to.

People and staff spoke positively about the acting manager at the service and the working culture.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We observed staff were kind and respectful when treating people. Relatives told us that they felt people were safe in the service. Records showed risk assessments were developed and staff had an understanding of adult safeguarding. We noted staff had attended various training programmes including health and safety, medicine and Mental Capacity Act 2005 (MCA). Records showed that new staff had been checked appropriately and were provided with an induction programme before starting work. This meant that there were good staff recruitment systems in place.

The care plans were personalised and were based on the needs of each person. The use of a handheld electronic system to record, review and monitor care meant that the provision and checking of support for people was more reliable and effective. Staff told us the system, together with the supervision and support they received from management, was useful to them carry out their duty.

People were provided with a range of activities. We noted that people took part in activities of their preference within the service and in the community. Staff offered people choices and supported them to make decisions. People were provided with food that reflected their preference. Where they assistance, some people were supported with their meals. Records showed that people had access to medical check and healthcare professionals.

A complaints procedure was in place and people and stakeholders could be sure that their concerns were taken seriously by the registered manager. Relatives told us that they could talk to staff and make a complaint if they were not happy about the service. People, relatives and staff were able to give feedback through various meetings and surveys. We also noted that incidents and accidents were monitored, and the registered manager ensured that the health and safety of the equipment and premises were checked. Records showed that medicines were administered and signed for by staff to confirm that people had their medicines as prescribed by their healthcare professionals.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found

Is the service safe?

The provider had taken steps to ensure that people were supported in an environment equipped with appropriate facilities. Staff had received various training courses including safeguarding. The provider had an effective recruitment process which ensured that people using the service were supported by staff who were appropriately checked. One person told us that they felt "safe" in the home.

Is the service effective?

We saw staff respected and involved people in their care. Each person using the service had a care plan which was regularly updated. The provider and senior managers visited the service to monitor the quality of care and to support staff. Progress reports on various aspects of the service were completed monthly and information was shared with the stakeholders.

Is the service caring?

People using the service told us they were happy living at the home. Staff listened to people and provided them with appropriate care and support. We noted that people's preferences were recorded and they were provided with services that reflected their cultural and religious needs.

Is the service responsive?

People told us they were satisfied with their care. We saw that staff responded to people's requests, for example, to go out to the shops. People were supported to attend medical appointments and we noted that the provider had enabled one person to obtain specialist equipment by through a referral to an Occupational Therapist (OT) assessment.

Is the service well-led?

The home did not have a registered manager. However, the provider visited the service at least twice a week and provided management and support to staff. We were informed by the provider that an acting up manager ran the home while a permanent manager was being recruited.