Hunters Lodge

About the service

Hunters Lodge is a residential care home providing personal care and support to older people and people with learning disabilities and/or autistic people, physical disabilities and dementia. There were seven people living there at the time of the inspection. The service can support up to nine people.

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

Right Support

The service supported people to have the maximum possible choice, control and independence. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. People were supported by staff to pursue their interests. Staff supported people to achieve their aspirations and goals.

The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. Staff did everything they could to avoid restraining people. The service recorded when staff restrained people, and staff learned from those incidents and how they might be avoided or reduced.

The service gave people care and support in a safe and clean environment. People had a choice about their living environment and were able to personalise their rooms. People benefitted from an interactive and stimulating environment.

The service made reasonable adjustments for people so they could be fully involved in discussions about how they received support, including support to travel wherever they needed to go. Staff supported people to take part in activities and pursue their interests and to stay in touch with people important to them.

Staff enabled people to access specialist health and social care support in the community. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. Staff supported people with their medicines in a way that achieved the best possible health outcome. Staff supported people to play an active role in maintaining their own health and wellbeing.

Right Care

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them.

People’s care and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice.

People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right Culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.

People received good quality care and support because trained staff could meet their needs and wishes. People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.

Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. Staff placed people’s wishes, needs and rights at the heart of everything they did. People and those important to them, including advocates, were involved in planning their care. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views.

People’s quality of life was enhanced by the service’s culture of improvement and inclusivity. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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

Why we inspected

We undertook this inspection to assess that the service is applying the principles of right support, right care, right culture.

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.

Hunters Lodge is a residential care home providing personal care and support to older people and people living with a learning disability, autism, physical disability and dementia. There were eight people living there at the time of the inspection. The service can support up to nine people.

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

People were not always protected from the risk of avoidable harm. Risks were not always appropriately assessed and care plans were not always clear and detailed. Some people’s care records lacked accurate, detailed, person-centred information. We found continued failings in the use of guidance for the administration of 'when required' medicines. 'When required' medicine protocols were not always person-centred or accurate. There was no system in place for checking the status and condition of window restrictors. The provider did not always operate safe and effective recruitment practices to ensure staff working with vulnerable people were suitable.

People’s communication needs and preferences were not always appropriately and consistently recorded. This meant staff did not always have enough detailed information to communicate effectively with people to understand their behaviours and wishes. Some people’s care records did not contain enough person-centred information for staff to ensure people had choice and control and to meet their needs and preferences.

Managers lacked some knowledge and understanding of regulations, guidance and standards. The provider did not display the most recent CQC rating. The provider’s audits were not always effective and had not identified the failings found by us during our inspection. This meant the provider was less likely to be able to identify areas for improvement. The registered manager did not have a good level of knowledge about the service and the management arrangements in place were not sufficient to drive enough sustained improvement. The provider continued to be in breach of five regulations.

Staff had received training in the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) and were appropriately supervised. The provider was in the process of arranging mental capacity assessments for people. Appropriate DoLS applications had been made and the provider always contacted the appropriate relative to seek consent when a person did not have the capacity to decide for themselves.

The provider had robust Infection Prevention and Control (IPC) policies and practices in place.

Staff received appropriate training and supervision and had the knowledge and skills to provide the care people needed. Staff knew people well and supported them to stay healthy.

The provider worked in partnership with other agencies and organisations to provide and improve people's care.

Despite some improvement since our last inspection, some of the planned improvements had not been fully embedded. The provider said they had prioritised their focus on dealing with the COVID-19 pandemic. This meant at the time of this inspection there was not enough evidence of consistent good practice over a sustained period of time.

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

Right support:

People lived in a shared household in a residential home in the community. People had their own bedrooms, could come and go as they pleased and have visitors whenever they liked. This meant people could live their own individual lifestyles.

Right care

The information in some people’s care records was person-centred but some people’s records did not have enough detailed person-centred information. This meant staff did not always have enough information to support all people in line with their interests and preferences. However, staff knew people well and this meant the support people received was mostly individual to their needs and preferences. Staff were caring and respected people’s dignity.

Right culture:

People’s ability to do things independently had not always been robustly assessed and care records did not always contain enough information about how staff should support people to do more things for themselves. It was not clear from the support provided and recorded whether people were as empowered as they could be and were living as independently as they could. Information in people’s care records about their interests was basic and did not contain enough detail about how staff should support people to live as full a life as possible.

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 inadequate (published 20 November 2020) and there were multiple 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 there had not been enough sustained improvement and the provider was still in breach of regulations.

Why we inspected

We carried out an announced focused inspection of this service on 30 March 2021.

We undertook this focused inspection to check the provider 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, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We also looked at IPC 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.

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

Enforcement

The overall rating for the service is requires improvement. We have identified breaches in relation to safe care and treatment; person-centred care; fit and proper persons employed; requirement to display CQC performance assessments and good governance.

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 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 also 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 overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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 six 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, 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.

Hunters Lodge is a residential care home providing personal care. The service can support up to nine people with varying needs including people living with dementia and people who have a learning disability.

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

The service failed to consistently protect people from the risk of avoidable harm because known risks were not always appropriately assessed. We found continued failings in the service's use of medicines. We identified a medicines error and found there were no arrangements in place to detect or record medicines errors. In addition, staff lacked guidance around the administration of ‘when required’ medicines.

The provider continued to operate unsafe recruitment processes. The provider continued to deploy staff without references and Disclosure and Barring Service checks.

Systems to prevent and control the risk and spread of infection were inadequate. Staff did not have appropriate facilities to change into and safely out of PPE. The registered manager failed to carry out Covid-19 risk assessments for people and staff. There was no auditing system in place for cleaning and decontamination and food continued to be stored unsafely in the fridge.

Staff received training, but the registered manager failed to undertake follow-up competency checks to confirm their understanding and whether further training was required.

People were not supported with mental health assessments and inappropriate Deprivation of Liberty Safeguards were applied for by the provider. This meant 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.

The provider continued to fail to maintain and make available to staff full and accurate care records. This meant systems were not in place to ensure staff had up to date information about people’s needs, risks and preferences.

Quality assurance processes remained inadequate. The registered manager’s auditing processes failed to identify and put right poor practices we found at the last inspection and which persisted into this one. Management arrangements were inadequate. A new manager had been appointed at the service, but the registered manager failed to ensure an adequate induction. This meant the new manager was unaware that a Warning Notice had been issued to the service for regulatory breaches at our last inspection. At this inspection the provider continued to be in breach of six regulations.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

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

Right support:

People did not always have maximum control of their lives. People’s mental capacity to make decisions was not assessed. People were not supported with individual programmes of activity based upon their choices.

Right care:

Inadequate governance of the service resulted in a lack of person-centred care for people. Staff did not always have access to people’s care plans. This meant people could not be assured that their needs could be met, or their risks managed in line with their preferences.

Right culture:

Poor leadership resulted in the systemic failure to improve the quality of care people received. Eight months after we identified that the provider was in breach of regulations related to the need for people’s consent, person centred care and people’s safety, the breaches continued. This meant the leadership behaviours required to drive improvements were not evident.

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 09 April 2020) and there were multiple 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 enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

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, Responsive and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those Key Questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement 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 Hunters Lodge on our website at www.cqc.org.uk.

Enforcement

The overall rating for the service has changed from Requires Improvement to Inadequate. This is based on the findings at this inspection. We have identified breaches in relation to people’s safety, mental capacity and person centred care as well as fit and proper staff being employed and good governance. 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

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.

Hunters Lodge is a residential care home providing personal care for up to nine adults with varying needs including learning difficulties and dementia. At the time of our inspection nine people were using the service.

The service was a large home, bigger than most domestic style properties. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home.

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

Risk assessments were in place for most people, however, some people’s risk had not been recorded. Some people’s Personal Evacuation Emergency Plans (PEEPs) were missing, and information about important fire checks could not be found or were out of date.

Some medicines were not recorded properly so it was not clear if people had the right amount of medicine when they needed it. When people only needed their medicine occasionally staff did not have the information they needed to tell them when this should be or why. There was no information to help staff know how people liked to take their medicine. Staff training on medicine management was out of date and the registered manager did not record staff competency around the administration of people’s medicine.

The registered person did not always properly assess risks relating to the environment. Things we identified at the inspection such as missing window restrictors and broken tiles, were put right straight away but we were concerned these things had not been identified before.

There was not always enough staff to support people safely. The registered manager mainly used agency staff to work at the service. We were worried about the quality of recruitment checks that had been carried out and that checks to make sure staff were safe to work with people had not been monitored or updated. Staff training was poor and was not refreshed very often so staff may not have the most up to date skills and knowledge to care and support people.

The registered person did not have systems in place to support people when they were unable to make particular decisions because they lacked the capacity to do so. Best practice guidance and the law was not always followed. People were not supported to have maximum choice and control of their lives and staff did not always support them in their best interests; the policies and systems in the service did not support this practice.

The registered person did not have effective systems in place to monitor, assess and improve the service. Care records were not always up to date and some important information was missing from some people’s records. The registered person had not identified the issues we found during our inspection and we were concerned about the time delay in making the improvements required by the London Fire Service.

People and their relatives told us they liked living at Hunters Lodge. They told us staff were kind and caring. Staff knew people well and were able to offer people choices about the food they ate, when they went to bed or woke up. People were supported to keep in contact with their family or friends. More independent people were supported to follow their interests in the community and at the service although there were less opportunities available for those people who were less 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 10 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

At this inspection we have found evidence that the provider needs to make improvement. Please see the safe, effective, responsive and well-led sections of this full report.

Enforcement

We have identified breaches in relation to person-centred care, the need for consent, safe care and treatment, good governance, staffing and fit and proper persons employed at this inspection.

Please see the actions we have told the provider to take at the end of this report. However, full information about CQC’s regulatory response to the more serious concerns found during inspections will be added to reports after any representations and appeals have been concluded.

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.

Hunters Lodge is a residential care home which provides nursing and personal care to adults with learning difficulties. The home has a maximum occupancy of 9.

At the time of our inspection the home had a registered manager. 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 and associated Regulations about how the service is run.

At the last inspection in December 2016 the home met all the key questions and was rated good in each with an overall good rating. At this inspection the home met all the key questions and was rated good in each with an overall good rating.

People told us they liked living at Hunters Lodge and the way that staff treated and supported them. People chose their own activities and when to do them. They felt safe living at the home and using facilities within the local community. When we visited there was a friendly, warm, and welcoming and atmosphere with people using the service coming from and going to activities. Frequent positive interaction took place between people using the service and staff. There was a variety of home and community based activities.

The records were accessible, up to date and covered all aspects of the care and support people received. This included their choices, activities and safety. People’s care plans were complete and the information contained was regularly reviewed. This enabled staff to perform their duties efficiently and professionally. People were encouraged to discuss their health needs with staff and had access to GP’s and other community based health professionals, as required. Staff supported people to choose healthy meal options and maintain balanced diets whilst meeting their likes, dislikes and preferences. This enabled them to be protected from nutrition and hydration associated risks. People told us that they liked the choice and quality of their meals.

People knew the staff that supported them well and the staff were very familiar with people, their likes, dislikes and preferences. They were well supported and enjoyed the way staff delivered their care. The care and support staff provided was professional, friendly and focussed on people as individuals and staff had appropriate skills to do so. The staff were well trained and accessible to people using the service. Staff said they liked working at the home and had received good training and support from the manager.

People said the management team was approachable, responsive and listened to them. The quality of the service provided was consistently monitored and assessed.

At this inspection staff told us they felt supported by the management and were given the opportunity to raise issues relating to their personal and professional development during staff and supervision meetings. We saw evidence that regular staff and supervision meetings were held. Staff received relevant training and were given the opportunity to obtain further relevant qualifications.

We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

We found the provider had taken reasonable steps to protect people from abuse. Although not all staff had received training in safeguarding vulnerable adults recently, they had a good knowledge about the signs and types of abuse and knew what action to take if they had concerns that people were at risk of abuse. People using the service told us they felt safe.

We found that there were effective recruitment and selection processes in place and that appropriate checks were undertaken before staff began work. However, we were concerned that some staff did not feel supported by the management and we found evidence which confirmed this. The majority of staff did not receive regular supervision, appraisal or training.

We reviewed records relating to people using the service, staff and the management of the service. We found the records were accurate and fit for purpose.