Swanage Lodge

Swanage Lodge is a care home for up to 6 adults with mental health needs. At the time of the inspection, 6 people were living at the service. The provider is a private limited company. They owned another registered care home and supported living services. The staff worked across all the services, which are geographically close together

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

People were happy at the service. They were involved in planning and reviewing their own care and made decisions about this.

There were enough staff; and they were trained, supported, and provided with the information they needed to care for people safely.

Risks to people’s safety and wellbeing were assessed, monitored and managed.

Medicines were managed safely. People had access to the healthcare services they needed to support them with their physical and mental health.

There were systems and processes to help monitor and improve the quality of the service.

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.

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 March 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 8 February 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 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, Effective and Well-led.

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 to good. This is based on the findings at this inspection.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) 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.

Swanage Lodge is a care home for up to six adults with mental health needs. At the time of the inspection, six people were living at the service. The registered manager also managed another registered care home and supported living services. The staff worked across all of the services.

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

Some aspects of the environment included health and safety hazards. The provider had not always fully assessed the risks of some activities. Nor had they made sure all plans to mitigate risk were personalised and took account of individual needs.

The provider's systems and processes for monitoring risk had not always been operated effectively.

There were some restrictions in place which the provider had deemed necessary to keep people safe. In some cases, these had been assessed and people had consented to the restrictions. However, this was not always the case and we spoke with the registered manager about making sure they appropriately documented these.

People's needs and choices had been assessed and planned for. People felt well supported and had good relationships with the staff.

The staff had suitable training and support and understood about their roles and responsibilities.

There were suitable systems for dealing with complaints and other adverse events, as well as learning from these to make improvements.

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 provider had restricted the management team and the systems they used to help make improvements at the service. They had developed an action plan following our last inspection and had made a number of improvements to the quality of the service.

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 rating at the last inspection was inadequate (Published 6 October 2021). At the last inspection we identified breaches in relation to safe care and treatment, safeguarding people from abuse and good governance.

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 but the provider remained in breach of regulations.

This service has been in Special Measures since 28 August 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment and good governance 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.

About the service

Swanage Lodge is a care home for up to six adults with mental health needs. At the time of the inspection, six people were living at the service. The registered manager also managed another registered care home and supported living services. The staff worked across all of the services.

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

People were not cared for in a safe way. There were risks within their environment which had not been monitored or mitigated which included failures to follow systems to manage infection prevention.

People's money was not safely managed. Records of financial expenditure were incomplete. In some instances, receipts were not available to account for how money was spent. One person was not being supported to manage their savings account in a safe manner as poor record keeping meant we could not confirm what savings they had and how their money had been used. We raised a safeguarding alert about this with the local authority.

The provider had not identified serious failings at the service or risks to people, despite recording that they had completed audits on different aspects of the service, such as health and safety, infection control and people's money. There had been a lack of oversight which led to poor practice and poor record keeping. Incidents were not recorded in a manner which allowed for provider oversight and lessons were not always learnt following incidents.

People's needs were not always met. One person who had complex needs was not being supported to manage their behaviours in a way which addressed their dual diagnosis of mental health and learning disability.

Medicines were generally managed in a safe manner with a few aspects which could be improved. We have recommended the provider reviews the guidance in relation to the management of medicines in care homes.

Three of the people who lived at the service told us they were happy at the service. Care workers spoke positively about management support and told us they thought there were enough staff and enjoyed working as a team.

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.

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.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The care provided by staff maximised people’s choice, control and independence. Care plans were mostly person-centred, and we made a recommendation the provider should review their systems and processes to achieve best practice when working with people who have learning disabilities and autism. Staff promoted people’s dignity, privacy and human rights. The ethos, values, attitudes and behaviours of the managers and care staff ensured people using services led confident, inclusive and empowered lives.

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

Rating at last inspection

The rating at the last inspection was good (published 7 May 2020).

Why we inspected

The inspection was prompted due to concerns received about this location and the other provider’s location. In particular, we were alerted to concerns about how people's money was being managed and staffing arrangements. A decision was made to inspect both of the provider's registered services on the same day to assess whether people were being safely cared for. We focused our inspection on the key questions of Safe, Responsive and Well-led because the concerns we had received related to these.

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 have found evidence that the provider needed to make improvements. Please see the Safe, Responsive and Well-led sections of this full report.

The key questions of Effective and Caring were not looked at on this occasion.

The overall rating for the service has changed from good to inadequate. 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 Swanage Lodge on our website at www.cqc.org.uk.

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 safe care and treatment, safeguarding service users from abuse and improper treatment and good governance 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 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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Swanage Lodge is a care home that provides accommodation and personal care for up to six people who require support with mental health needs. The care home provider is Parvy Homes Limited. The registered manager is the owner and has three other care services situated near by Swanage Lodge. At the time of the inspection six people were using this service.

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; the policies and systems in the service supported this practice.

People were supported to make day to day decisions and to retain their independence. Staff encouraged people to take part in activities and supported them in their diverse needs. People told us they chose their meals and helped prepare them. Care workers prompted people to drink enough to remain hydrated.

The provider notified the local authority if they identified a safeguarding adults concern. Medicines records were completed without errors or gaps and medicines were stored in a safe manner.

Staff had received an induction prior to commencing their role. They had completed training to support them to undertake their role.

People spoke about the management team and care workers in a positive manner.

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 on 22 and 24 August 2017 (published on 5 October 2017).

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

Swanage Lodge provides support and accommodation for up to six people who have a mental health diagnosis. There were six people using the service at the time of this inspection.

There was a registered manager in post who was also the provider and had a second registered location near to Swanage Lodge. 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 last inspection took place on 26 and 27 April 2016 when we rated the overall service and Safe and Effective domains as Requires Improvement. We had previously found there needed to be improvements in relation to obtaining consent for decisions made about people’s lives and ensuring there were systems and processes in place to prevent abuse of people using the service. At this inspection we found improvements had been made in these areas.

Staff received training on safeguarding adults from abuse and there were policies and procedures in place. Those staff we asked knew what to do if they thought a person using the service was at risk of being abused.

There was an ongoing safeguarding investigation taking place at the time of this inspection. This had not been concluded at the time of writing our report.

Feedback from people using the service, staff we spoke with was positive about the service.

The atmosphere in the service was relaxed and we saw that staff chatted with people to make sure they were happy.

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

People’s care records included people's needs and preferences. Potential risks had been identified and assessed to guide staff on how to support people appropriately. We saw information had been reviewed on a regular basis.

People were involved where possible with agreeing to the support they received. House meetings were held regularly to encourage people to voice their opinions of the service.

People were supported to be as independent as they could safely be. Some people went out without staff and accessed various places in the community. Staff went with people on holidays and assisted them to see their family and friends.

There were checks on a range of areas in the service, including health and safety and medicines to ensure people received safe good care and that improvements were made where needed.

Staff continued to receive support through one to one and group meetings. They also received an annual appraisal of their work. Training on various topics and refresher training had been arranged in various ways that were relevant to staff member's roles and responsibilities.

There were sufficient numbers of staff working to meet people’s needs. Recruitment checks were carried out to make sure staff were suitable to work with people using the service.

People received the medicines they needed safely.

People had access to the health care services they required and their nutritional needs were being met.

There was a complaints procedure available and people knew to talk with staff if they had a complaint.

The service is a care home without nursing and provides accommodation and personal care to up to six people with mental health needs. When we inspected, six men and women with mental health needs were using the service.

There was 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 received training on safeguarding adults from abuse and there were policies and procedures in place. However, there were no clear systems and processes in place to demonstrate how all allegations would be effectively investigated.

Staff had undertaken training in the Mental Capacity Act (MCA) 2005 and the registered manager was aware of their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS). We were told and saw that people were given choices and the opportunities to make decisions. However, people’s ability to make decisions was not clear on their care records. Also there was a restriction for people in that they could not access the kitchen without a member of staff and this had not been risk assessed or identified by staff as a restriction.

People had various levels of independence and required different levels of support and encouragement. Staff understood people's individual needs and knew how to motivate them.

People’s nutritional needs were being met. Staff supported people to cook meals where they were able to.

Staff received the training they needed to provide them with the skills and knowledge to care for and support people effectively.

There were enough staff on duty day and night to make sure people’s needs were met in a safe and timely way.

The provider carried out checks to make sure staff were suitable to work with people using the service.

Care plans were in place and people had their needs assessed. Care records reflected the needs and wishes of the individual and included information about these needs so the staff could support them.

People had a range of risk assessments in place to help them maintain their independence and to guide staff in how to support them.

The health needs of people were being met. Staff had received support from healthcare professionals and worked with them to ensure people's individual needs were being monitored and met.

A range of activities were offered to people and they had the chance to engage in these both in house and in the community with each other. People also had the opportunity to go on holiday.

The provider had a complaints procedure and people told us they knew how to make a complaint or what to do if they were unhappy about something.

People received their medicines as prescribed and in a safe way and there were records to show these had been administered.

There were systems in place to monitor the quality of the care being provided.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to systems and processes had not been established or operated effectively to protect people from abuse. The provider had not also not acted in accordance with the Mental Capacity Act.

You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary is based on discussions with management during the inspection, speaking with relatives of people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Staff were familiar with people's risk assessments and how to manage and mitigate those risks.

There were suitable systems and procedures for managing medicines and evidence of these procedures being followed carefully and correctly to ensure medication was stored, administered and disposed of safely.

Systems were in place to make sure accidents and incidents were reported along with complaints and other concerns and action taken when required. This reduced risks to people and helped the service to continually improve its performance.

There were procedures for managing emergencies. Staff had received appropriate training and were aware of relevant procedures and contacts to access help and support.

Is the service effective?

People using the service experienced care that was planned and delivered to meet their needs and reduce any risks. Assessments were undertaken prior to using the service using input from people and their relatives, and other health professional involved in their care. Care plans were personalised and took account of preferences, cultural and religious requirements.

Care needs were reviewed on a regular basis and care plans could be modified if needs changed. Records showed the care delivered reflected the current care plan and reviews were all fully documented or up to date. Regular reports were prepared by care staff to make sure the care and support provided matched current needs. People were encouraged to engage in activities and life inside and outside the home and to be involved in managing their care as far as possible.

Staff had regular training and supervision to ensure their skills were up to date and appropriate. This helped to ensure people received a good quality service

Is the service caring?

We observed that people were cared for by empathetic staff who demonstrated a good understanding of people's individual needs, behaviour and preferences. Staff we observed communicated well with people and were patient and friendly.

People we spoke with told us they were happy with the care and support provided and that staff were kind and supportive in meeting their needs. One person said, 'The staff are very good. They're always helpful and willing to help out.'

Is the service responsive?

People using the service had regular opportunities to express their views and opinions. Weekly meetings were very well documented and detailed issues raised and any resulting action points.

Monthly staff meetings were held so any concerns could be raised and addressed promptly and changes made to the care and support provided if required.

There was a written complaints procedure which was readily available for people using the service. No written complaints had been recorded but there was evidence of informal complaints having been dealt with at house meetings in a timely and appropriate manner.

Is the service well-led?

The provider had a variety of systems to monitor the quality of service provided and audit their performance.

People using the service and their relatives were provided with information about the service and were contacted regularly to obtain their feedback and views.

There were appropriate procedures for dealing with complaints and reporting accidents and incidents.

At this inspection we found that the provider had taken steps to provide care in an environment that was adequately maintained. We met with the manager and saw records that confirmed that staff had been checking the fire doors on a weekly basis to ensure that they were closing. We carried out a tour of the home with the manager. We checked the fire doors and those that had not closed at the previous visit were closing properly. However, three bedroom doors did not fully close when we checked them.

We informed the London Fire and Emergency Planning Authority (LFEPA) of this as they carry out checks in services to ensure that appropriate steps are taken in relation to fire safety.

The manager confirmed that there had been issues with the equipment the home was using to ensure doors closed safely and not too quickly which might place some people using the service at risk of harm. On the same day of the visit the manager confirmed to us in writing that the fire doors had all been fixed and were closed properly which protected people in the event of a fire occurring in the home. He also told us that these doors would be checked daily to ensure they always closed appropriately. This will be checked during our next inspection visit.

Before people received any care or support they were asked for their consent and the provider acted in accordance with their wishes. Staff told us they supported people to make daily decisions about their lives. One person said 'I can choose where I go and I like to visit the shops and my family.'

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Overall care records provided staff with a good picture of each person, their needs and how these were to be met. Appointments were recorded if people saw a healthcare professional. This included input from the GP and dentist. This ensured that staff could monitor people's health needs and respond accordingly if they changed.

The provider had not taken steps to provide care in an environment that was adequately maintained. We found two fire doors that did not close properly and therefore would not protect people if a fire occurred.

There were enough qualified, skilled and experienced staff to meet people's needs. We viewed the rota and saw that the majority of time there were two care staff on during a shift. One person said there was always a member of staff to talk to if they wanted to have a chat with them. The manager was based in the home and was available to assist people and staff if they needed support.

Various audits took place in order to monitor the running of the home and any issues identified were recorded so they could be addressed. The staff team obtained the views of people in different ways. We saw that house meetings took place on a regular basis where people could hear news about the home and share their views. The manager confirmed that satisfaction surveys would be given to people living in the home, their relatives and professionals.