Shrub End Lodge

About the service

Shrub End Lodge is a residential care home providing accommodation and personal care for up to 6 people. At the time of the inspection, 5 people were living in the service. The premises is a residential property in keeping with the other houses in the area.

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

Right Culture

Quality assurance systems were not always robust, and improvements were needed in relation to management of environmental risks, MCA processes, recruitment, and training. The provider was not present at the inspection, and we were not assured the manager overseeing the service had sufficient knowledge in relation to regulatory and legislative requirements and current best practice guidance.

People told us they liked living at the service and were happy with staff support. A person told us, “It is lovely here, staff are magnificent to me. They are excellent.”

People were supported by staff and management who knew people very well. People and those important to them were involved in planning their care.

Right Support:

Not all environmental risks had been mitigated and whilst the manager did respond to our concerns and sent us information following the inspection, the management of Legionnaires had been a recommendation in a previous inspection which had not been met. Staff had training on how to recognise and report abuse and they knew how to apply it. Medicines were managed safely

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

Staff enabled people to access specialist health and social care support in the community. People were able to personalise their rooms.

Right Care:

Staff respected the people they supported and provided care that was kind and caring. Staff supported people to take part in activities and pursue their interests in their local area, however, we received some feedback people would like to go out more. Staff responded to people’s individual needs.

Staff had received training in some mandatory areas including fire, infection control, first aid and dementia awareness. However, there remained gaps in staff training.

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 on 12 December 2018).

Why we inspected

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.

We received concerns in relation to governance processes, safeguarding and MCA processes. As a result, we undertook a focused inspection to review the key questions of safe, effective, and well-led only.

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 good to requires improvement based on the findings of this inspection.

We have found evidence the provider needs to make improvements. Please see the safe, effective, and well led sections of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to staff training and governance arrangement at this inspection.

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.

We found the following examples of good practice:

The registered manager was following the government’s guidance on whole home testing for people and staff.

Good infection prevention control practices had been implemented such as wearing masks. There was a good supply of PPE and hand sanitiser was available.

The registered manager had increased the frequency of cleaning in the service and implemented cleaning for high touch areas such as door handles and light switches.

Staff had received training on infection prevention.

There was clear guidance and signage in the service to help prompt staff to safely work whilst minimising the risk of spreading infection including effective hand washing.

People living in the service were encouraged to try and maintain social distancing.

People were encouraged to stay in regular contact with relatives through window visits.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last 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.” Registering the Right Support CQC policy

The service had a Registered Manager in post. 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.

Staff knew people well and had some training to provide appropriate care and support to people in most situations. However, they had limited understanding and training in the mental capacity act and deprivation of liberty safeguards. Consequently, people were not always supported to have maximum choice and control of their lives in the least restrictive way possible. In addition some specific care need training had not been provided to staff supporting people with specific needs, such as Dysphasia Training, where a person is at risk of choking. Consequently we have made a recommendation around these learning needs.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Risks to people were identified, assessed and where appropriate reduced or discussed with people. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. The management of medicines was safe and medication was administered by staff who were competent to do so.

People were supported to develop food choices, had their nutritional and hydration needs met and had a positive dining experience . Referrals were made to health professionals when required and health needs were being met on a day to day basis.

Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care that met their needs.

People and their relatives were involved in the planning of their care. Care plans were sufficiently detailed about a person’s care and support needs, and reviewed on a regular basis. People were supported to follow interests and participate in social activities of their choice and preference.

The service had quality assurance systems in place to monitor and support good care and these were reviewed on a regular basis. The registered manager had processes in place to deal with complaints

Further information is in the detailed findings below

There were five people living in the service when we inspected on 28 April and 26 June 2016. This was an unannounced inspection.

There was a registered manager in post. The registered manager was also the provider. 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 received care that was personalised to them and met their individual needs and wishes. Staff respected people’s privacy and dignity and interacted with people in a caring, compassionate and professional manner. They were knowledgeable about people’s choices, views and preferences and acted on what they said. The atmosphere in the service was friendly and welcoming.

Systems were in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

Staff knew how to minimise risks and provide people with safe care. Procedures and processes guided staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how risks to people were minimised.

Recruitment checks on staff were carried out with sufficient numbers employed who had the knowledge and skills to meet people’s needs.

Appropriate arrangements were in place to ensure people’s medicines were obtained, stored and administered safely. People were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

People were supported to make decisions about how they led their lives and their views were central to how the service was provided. People were supported in accordance with the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were assessed and met. People were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner.

Processes were in place that encouraged feedback from people who used the service, relatives, and visiting professionals. There was a complaints procedure in place and people knew how to make a complaint if they were unhappy with the service.

There was an open and transparent culture in the service. Staff understood their roles and responsibilities in providing safe and good quality care to the people who used the service. Audits and quality assurance questionnaires were used to identify shortfalls and drive improvement in the service.

People confirmed they were consulted about the care and support that they were provided with and understood the care and treatment choices available to them. One person told us, 'They (staff) talk to me and make sure I am ok and look after me if I need it. If I am sick they take me to see the doctor.'

We looked at three people's care records which provided information for staff on how to meet people's individual health and care needs. We saw that people's choices and preferences were reflected in the care records and written in a way that promoted their independence.

We spoke with four people about the quality of the food. Feedback was positive.

People we spoke with told us they felt safe at Shrub End Lodge and trusted the staff and provider. They confirmed they were looked after by staff and their needs were met.

We looked at staff records and spoke with two members of staff who told us they were being appropriately supervised and supported. Staff we spoke with were knowledgeable about the people they supported and how to meet their needs.

We saw that the provider had systems and procedures in place to regularly monitor and assess the quality of the service provided.

The plan of care was detailed about the individual needs of the person living at the service. The care plan had been signed and dated by the person receiving the care. There were records of review of the plans and a record of the daily activities chosen by the person involved.

The provider had made arrangements with a pharmacy to supply medication to the home. Staff had received training in the safe administration of medication.

The provider had made arrangements for sufficient staff to work at the home to provide support to people. Staff had the appropriate qualifications and experience to care for the needs of the people who lived at the service.

We found that people were not directly aware of the complaints process but told us that if they had any concerns they would raise them with the staff or the manager. One person told us, "I would speak with staff and they would help me." Another said "I don't have any complaints. I am very happy here."