Shore Lodge provides accommodation for up to ten adults who have physical and learning disabilities. It is part of the Leonard Cheshire Disability (LCD) organisation. The home is situated on the outskirts of Dartford in Kent.This inspection was carried out on 04 March 2016 by one inspector. It was an unannounced inspection. There were 9 people using the service at the time of the inspection.
There was a manager in post who was registered with the Care Quality Commission (CQC). 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.
Following the last inspection in July 2015 the registered provider and registered manager were served with warning notices in respect of breaches the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider sent us an action plan addressing the requirements of the notices. At this inspection we found that the required improvements detailed in the warning notices had been made. At the last inspection we also issued a requirement notice in relation to consent. At this inspection we found that, although improvements had been made, the registered manager and staff did not fully understand the requirements of the Mental Capacity Act 2005.
Staff were trained in the principles of the Mental Capacity Act 2005 (MCA), however we found that assumptions had been made in respect of people’s mental capacity to make decisions. It was recorded on people’s care plans that they did not have the capacity to make decisions. The registered manager and staff had not understood that an assessment of a person’s capacity needed to be carried out for each decision to be made, where they believed the person may be unable to make the decision. This placed people at risk of losing their right to make a decision because assumptions were made or because they had not been able to make a previous decision. This was a breach of regulation. You can see what action we told the provider to take at the back of the full version of the report.
Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were completed based on the needs of the individual. Staff understood what action they needed to take to keep people safe. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Action had been taken to reduce the risks to people’s safety.
There were sufficient staff to meet people’s needs. Thorough recruitment procedures were in place to ensure staff were suitable to work with people.
Medicines were stored, administered and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.
The service was clean, well maintained and designed to meet the needs of the people that used it. Risk within the premises and in the use of equipment had been assessed and managed effectively. Staff knew how to minimise the risk of infection spreading in the service.
Staff knew people well and were trained and competent to meet people’s needs. They had the opportunity to receive further training specific to the needs of the people they supported. Staff felt supported and received one to one supervision sessions and an annual appraisal of their performance. Staff were clear about their responsibilities. This ensured they were supported to work to the expected standards.
The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted where needed and the least restrictive options were considered as per the Mental Capacity Act 2005 requirements.
People were provided with meals that were in sufficient quantity and met their needs and preferences. People enjoyed their meals. Staff knew about and provided for people’s dietary preferences and restrictions.
People were promptly referred to health care professionals when needed. Staff included advice from health professionals in individuals’ care plans and records showed that this advice was followed.
Staff were caring and treated people with kindness and compassion. They knew each person well and understood what was important to them. Staff understood how to communicate with each person. People’s privacy was respected and people were assisted in a way that respected their dignity.
People were involved in their day to day care. People participated in reviewing their care plans as far as they were able and relatives were invited to attend reviews with people’s consent. Personal records included information about people’s life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves, however this was not planned for proactively as part of the care plan. We have made a recommendation about this.
Information about the service, the facilities, and how to complain was provided to people and their relatives. People were asked their views about the service at regular intervals, however the registered manager had not considered alternative ways to seek the views of those who did not use verbal communication or could not complete a questionnaire. We have made a recommendation about this.
People were supported to take part in activities that responded to their individual needs and interests. Work was underway to develop more opportunities for meaningful activities and occupation for people.
Staff told us they felt supported by the registered manager. The team had worked hard to develop the culture of the service to reflect the person centred principles the registered provider committed to deliver. Improvements had been made, but it was too early to see that these had been fully embedded in the culture of the service. We have made a recommendation about this.
The registered manager was open and transparent in their approach and receptive to recommendations for improving the service. The registered provider ensured the registered manager kept up to date with any changes in legislation that might affect the service and they had carried out regular audits to identify how the service could improve. The registered manager had acted on the results of these audits and made necessary changes to improve the quality of the service and care.
We recommend that the registered manager review each person’s support plan to ensure it outlines how staff can promote their independence and help them to achieve their goals and aspirations.
We recommend that the registered manager review how the views of people using the service are sought to ensure it meets individuals’ communication needs.
We recommend that the registered manager continue to closely monitor staff practice and to regularly assess the culture of staff practice to ensure it reflect person centred values.