Caxton Lodge

We found the following examples of good practice.

Visiting to the home took place as per current guidance and appropriate testing and checks were in place. The home had ample supplies of appropriate PPE. Where visiting couldn’t take place due to isolation people were supported to make telephone calls for regular contact.

Staff completed online training including putting on and taking off PPE, hand hygiene and other IPC and COVID-19 related training and updates.

The service was meeting the requirement to ensure non-exempt staff and visiting professionals including healthcare and maintenance workers were tested and vaccinated against COVID-19.

The provider’s policies on visiting, and infection prevention and control were all up to date and had been updated regarding COVID-19 government guidance. Risk assessments for staff and people were in place to minimise further risks.

Where people lacked capacity to make decisions were supported appropriately with best interest decisions relating to COVID-19 including testing and vaccination.

Social distancing practices were in place for people and staff in all communal areas and where appropriate and this was carried out safely.

The acting manager ensured extra cleaning of the home took place and that regular checks were carried out ensure infection prevention and control standards were met. Risk assessments relating to COVID-19 were in place for people who used the service and staff.

People and staff were tested regularly which helped identify cases of COVID19 in a timely manner.

Caxton Lodge provides residential care for younger adults with a learning disabilities or autistic spectrum disorder, physical disability or sensory impairment.

The service is registered to support up to 10 people, and 10 people were using the service when we inspected. This is larger than current best practice guidance. However, the risk of these things having a negative impact on people was mitigated as the building design fitted into the residential area and the other large domestic homes of a similar size. There were no identifying signs to indicate it was a care home and staff did not wear uniforms to identify them as care staff when coming and going with people.

Staff provided support in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures 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 autism to live meaningful lives that include control, choice, and independence.

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

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.

People felt safe with the support staff provided. Staff understood people’s needs and risk assessments were in place to support them to provide safe care.

New staff were safely recruited and had been trained to identify and respond to any safeguarding concerns. Medicines were managed and administered safely. Accidents and incidents were monitored to make sure lessons would be learned if things went wrong.

Staff received regular training, supervisions and an annual appraisal. They felt supported by management and worked closely with healthcare professionals to make sure people received effective care. Staff supported and encouraged people eat and drink enough and to have a varied and balanced diet.

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. Appropriate applications had been made when necessary to deprive people of their liberty.

Staff were caring and treated people with dignity and respect. They understood people’s communication needs and used accessible information to help people understand choices and make decisions.

People’s care was planned and delivered in a person-centred way. Regular reviews helped make sure the support provided continued to meet people’s changing needs.

People had the opportunity to take part in a wide range of activities and to pursue their hobbies and interests. They were supported to maintain regular contact with family to avoid social isolation.

There was a person-centred culture within the service. Management were open and responsive to feedback. Systems were in place to respond to any complaints about the service. Audits helped monitor the quality and safety of the service. People, staff and relatives praised the management of the service, describing the registered manager as approachable and supportive. Information was recorded and effectively shared to make sure people’s needs were met.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was requires improvement (report published 23 November 2018).

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 reinspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 4 and 8 October 2018 and was announced. We gave 72 hours’ notice of the inspection because the location was a small care home for adults who are often out during the day and we needed to be sure people would be in when we visited. At the time of our inspection there were 10 people living there.

The service was larger than the small local community-based settings recommended for providing good quality care for people with a learning disability. The majority of people who used the service were funded by other neighbouring local authorities. Good practice guidance recommends providers and commissioners should be working towards reducing the number of ‘out of area’ placements. Despite this the provider and registered manager had taken steps to develop the service 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 had a registered manager. They had been the registered manager since December 2015. A registered manager is a person who has registered with the 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. The registered manager was supported by a deputy manager and a director of care in the management of the service.

At our last inspection in March 2016, we rated the service ‘good’. At this inspection, we found improvements were needed to make sure the service was consistently safe and well-led.

Statutory notifications had not been submitted when legally required. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We are dealing with this matter further outside of the inspection process.

The risk of choking had not been consistently well-managed. This placed people at increased risk of harm. We shared concerns regarding fire safety with North Yorkshire Fire and Rescue Service who visited Caxton Lodge. We will follow-up the actions needed to improve fire safety in more detail outside of the inspection process. We made a recommendation about developing audits and quality monitoring to more robustly monitor these shortfalls in future.

Staff were safely recruited. They were attentive to people’s needs and quick to respond during our visits when people asked. Staff supported people to take their prescribed medicines.

Detailed plans were in place to guide staff on how to safely support people who might be anxious or upset and act accordingly.

Staff completed regular training on how to effectively meet people’s needs. The registered manager used supervisions and appraisals to monitor staff’s performance and support their continued professional development.

Staff sought people’s consent and supported them to make informed choices. When people lacked the mental capacity to make particular decisions, best interest decisions had been made and documented on their behalf. The registered manger had made appropriate applications to deprive people of their liberty. This ensured their rights were protected.

The service was spacious and adapted to meet the needs of the people living there. It was a short walk to the local shops and amenities. Sufficient staff were deployed to enable staff to provide person-centred care and to support people to access the wider community.

People told us staff were kind and caring. We observed people and staff knew each other well and shared good caring relationships. Staff supported people to meet their personal care needs to help maintain their dignity. Staff treated people with respect. They offered people choices and listened and responded to people’s requests. Information was available in an accessible format if people needed this.

People’s care plans contained person-centred information to guide staff on how best to meet their individual needs. Staff worked closely with people who used the service and showed a good understanding of their needs. This helped staff to provide person-centred care. We made a recommendation about developing an end of life care policy.

Staff helped people to take part in a wide range of activities and to do the things they enjoyed. The provider had a complaints procedure to govern how they managed and responded to any complaints about the service.

People told us the service was well-led. Staff worked closely with professionals to make sure people’s needs were regularly reassessed and that the care and support met their needs.

Caxton Lodge is registered to provide residential and personal care for up to ten people with a learning disability and an associated visual impairment. The home is a large Victorian building near to Ripon town centre. There is a garden to the rear of the property and parking for visitors and staff.

The home has a registered manager in place. 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 found people were cared for and supported by sufficient numbers of suitably qualified and experienced staff. Robust recruitment procedures were in place to make sure suitable staff worked with people who used the service and staff completed an induction when they started work. Staff received the training and support required to meet people’s needs.

Staff had received training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). Staff ensured that people were supported to make decisions about their care where possible. People were cared for in line with current legislation and they were consulted about choices.

Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. Relatives we spoke with also told us they thought people were safe at the home. There were systems and processes in place to protect people from the risk of harm. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely.

People’s care plans contained sufficient and relevant information to provide consistent care and support. People’s mealtime experience was good with ample assistance available for those who required one to one help with their meal. People received good support which ensured their health care needs were met. Staff respected people’s privacy and dignity.

Staff had been responsible for encouraging and supporting people with new interests which they had benefited from. The home made a particular effort to communicate with relatives and other interested parties to make sure that people were ‘given a voice’ despite their complex needs.

People were supported to take part in activities and daily occupations which they found both meaningful and fulfilling. Relatives told us that they appreciated how staff had thought of new ways to make sure people could join in daily routines and events they could enjoy.

We were told by relatives, and we also observed throughout our visit, that people were treated with patience and kindness. Staff responded quickly to people’s changing needs and knew people well enough to know when a subtle facial expression or a sound indicated they needed assistance or support. Staff knew how best to communicate with people. This included the use of gestures, touch, key phrases and noises, which the person understood. We saw people smiling and engaging with staff. Needs were regularly monitored through staff updates and staff meetings. We saw staff had a good rapport with people and worked together as a team.

The home was kept clean and tidy and staff were trained in infection control.

People’s needs in relation to their diet were met. We saw plenty of food and drinks being made available throughout our visit. People seemed to enjoy their meals and their individual preferences had been incorporated into menus. The dining arrangements were organised to make sure people were settled and calm during their meal. This included three sittings, so that smaller groups were seated at any one time so that people could be given the individual attention they needed. We observed that the dining experience was pleasant and that people had choice and variety in their diet.

The service had good management and leadership in place. Relatives and people who used the service had opportunities to comment on the quality of the service and influence service delivery. Effective monitoring systems were in place, which made sure people received safe, quality care. Complaints were welcomed and were investigated and responded to appropriately. The registered manager and deputy worked alongside the team, supporting the staff to make sure people received the care and support they needed. Staff told us they got on with the registered manager and that they were approachable and listened to them.

There were quality assurance systems in place which were used to make improvements to the service. We sampled a range of safety audits and looked at the results of a recent quality survey sent out to relatives and healthcare professionals.

We spoke with three people who used the service. They told us they were happy living in the home and were given choices as to how they spent their days. One person said 'I like living here. I went out for a meal yesterday and it was nice. I play the piano twice a week' Another person described what they did on individual days and said they were very happy living in the home. Some people were unable to communicate verbally with us but we observed them doing various activities and interacting with staff.

Is the service caring?

Three people we spoke with said they were happy with the care they received. We spoke with three members of staff who gave examples of how they treated people with dignity and respect and involved people in their care. We observed staff speaking with people in a kind and caring manner and found that people were comfortable in the presence of staff.

Is the service responsive?

During our visit we looked at three peoples care plan records. Each contained assessments of people's individual needs. We saw that any risks to people's safety were determined and care was planned to mitigate any risks that were identified. We saw that risk assessments had been reviewed but some were not up to date. We saw that healthcare professionals were involved in people's care and treatment when required.

Is the service well led?

The home carried out a quality assurance survey which was sent to families and other professionals involved in peoples care. We saw that families and other professionals were happy with the care. We saw that audits were carried out across areas such as medication, infection control and care records. The audits we saw demonstrated that good standards of care were in place and that any actions required were cascaded to staff for improvement.

We found that people who use the service, their representatives and staff were asked for their views on the care and treatment and they were acted on. We saw that the provider held regular meetings with people and their families.

People who lived at Caxton Lodge had access to a variety of activities that included horse riding, gym, piano lessons and shopping trips.

We saw that people had a choice of well-cooked and nutritious food. Staff monitored people's weight and recorded the food and fluid intake of people who they had identified as being at risk of dehydration or malnutrition and took appropriate action promptly.

We also found that staff received regular training and were given the support they needed to carry out their jobs properly.

We saw that the area manager undertook quality audits and worked to an action plan to resolve any outstanding matters that had been identified. They confirmed that they visited the home at least weekly. However, Caxton Lodge had until recently been without a manager and therefore they had been based there to offer managerial support and stability to the home. During the inspection we spoke with the recently appointed new manager who was undergoing an induction program. When we spoke with them they said that they had settled very well at Caxton Lodge and were looking forward to working at the service.

We spoke with a visiting professional from the community Mental Health team, who told us they had no concerns and thought the home provided a good service.

Staff told us they felt settled and happy in their jobs, and were well supported by their manager and area manager. Comments included 'It's a good service and the people get out and about all the time, they're well known in the local area' and 'The manager is brilliant and I really like it here.' The recently appointed manager and area manager were present for the inspection to help answer questions and advise us.