We carried out a review of the data available to us about Park Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Park Lodge, you can give feedback on this service.
Park Lodge is a residential service providing personal care for up to 8 people with a learning disability. At the time of the inspection there were 7 people living at the service.
People’s experience of using this service and what we found
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.
Right Support
People were supported to have maximum possible choice, control and independence. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Some relatives felt people would benefit from experiencing a wider range of activities, which the registered manager was trying to facilitate. Staff supported people to achieve their aspirations and goals. People were supported safely with medicines and staff proactively addressed any issues, which might arise and took appropriate action to reduce their occurrence. Infection prevention and control practices reflected current guidance.
Right Care
People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to people’s individual needs. Staff understood how to protect people from poor care and abuse. 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. We discussed enhancing the rotas to ensure they indicated exactly what 1:1 and 2:1 people received. On the whole, people’s care, treatment and support plans reflected their range of needs, and this promoted their wellbeing and enjoyment of life. The service worked well with other agencies.
Right culture
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 always tried to place people’s wishes, needs and rights at the heart of everything they did. Staff were aware of and were working to best practice guidance for supporting people with a learning disability and/or autistic people.
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 rated inspection for this service was good (published 16 March 2018).
A focused inspection was completed 30 March 2021, which looked at looked at infection prevention and control.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
This report only covers our findings in relation to the key questions safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Park Lodge on our 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.
We found the following examples of good practice.
• Systems were in place to help prevent people, staff and visitors from catching or spreading infection. Every staff member and visitor had their temperature taken at the door and were given appropriate personal protective equipment (PPE) to wear. Every visitor had to have a lateral flow test, complete a health declaration and use hand sanitiser upon entering the home.
• The environment was clean. Additional cleaning was taking place around the home, including of frequently touched surfaces.
• There was sufficient PPE such as masks, aprons, gloves and visors. The registered manager and deputy manager carried out weekly stock checks to ensure the home always had maximum levels of PPE.
• Staff had undertaken training in Infection prevention and control (IPC) as well as putting on and taking off PPE. There was an Infection control champion in place who carried out IPC audits and observed staff to ensure they were competent in IPC practices.
• Staff supported people’s social and emotional wellbeing. People were supported to keep in touch with their family members via video or telephone calls as well as socially distanced garden visits.
• People and staff were taking part in the COVID-19 regular testing programme.
Further information is in the detailed findings below.
At the last inspection, the service was rated good. At this inspection, we found the service remained good.
Park Lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Park Lodge accommodates eight people. At the time of inspection the service was providing support and care for seven people.
The manager had started the application to become the registered manager at Park Lodge. 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.
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.
The provider had safeguarding systems in place to ensure people were protected from abuse and harm. Staff were aware of the provider’s whistleblowing process and expressed their confidence that the manager would deal with any concerns appropriately.
The provider recorded, collated and analysed safeguarding concerns and accidents and incidents to identify any patterns or trends for lessons learnt.
Where risks were identified, they were assessed and managed to minimise the risk to people who used the service and others.
An effective recruitment process was in place. Sufficient staff were deployed to ensure people remained safe. New staff completed an induction and shadowing period. Training was up to date. The manager had an action plan in place to ensure staff received supervision.
Appropriate arrangements were in place for the safe administration and storage of medicines. The provider ensured checks were in place to maintain the safety of the home. Systems were in place to ensure people would remain safe in the event of an emergency.
Staff understood and applied the principles of the Mental Capacity Act (MCA), and were aware of people’s rights when they could not consent themselves. People were involved in all aspects of decision making about their care and treatment.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.
The manager consulted with people and their relatives when making changes at the home. People were supported to personalise their own rooms.
The service ensured people received care and support from healthcare professionals including GPs and community nurses. People were supported in maintaining a healthy and balanced diet.
People were treated with dignity and respect. Staff had a sound knowledge of the people they supported. Care plans were detailed and reflected people’s specific needs. Reviews were regularly completed.
People were supported to follow their interests and take part in social activities. Relatives told us they were made welcome at the home.
The provider had a comprehensive system to audit various aspects of the running of the service. These included checks of the medicines and care plans. The manager had developed an action plan to deliver improvements throughout the service including accessible information as standard.
Further information is in the detailed findings below.
Due to the complex needs of people living at the home not everyone was able to share their views about the service with us but we did spend time with people in communal areas observing the care and support they received.
A registered manager was in post and had been registered since 26 January 2016. They had been in post since November 2015. 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.
We carried out a comprehensive inspection on 29 and 30 June 2015 and breaches of legal requirements were found. We issued warning notices and requirement notices. We asked the provider to take action to make improvements. The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service, staff or visitors. Care and treatment was not always planned and delivered in a way that was intended to ensure people’s safety and welfare. Staff had not received all the training they needed or professional development, supervision and appraisal. The provider submitted an action plan detailing how they would achieve improvements. The service was expected to be compliant by 21 September 2015.
During the inspection on 3 and 4 February 2016 we found improvements had been made.
Some relatives told us they thought communication from the organisation could improve. They felt communication around the care of their family member was good.
Comprehensive risk assessment and management plans were in place. Staff explained they were involved in completing care records and their experience was being used to benefit people.
Accidents and incidents were recorded and analysed to identify trends and triggers. Support strategies were reviewed in response to findings from the analysis.
Medicines were managed safely. Some people received their medicines in liquid form as staff had identified they did not like the texture of certain tablets. Staff understood why people had been prescribed certain medicines.
Staff said they felt well supported by the registered manager and had attended supervisions on a regular basis. Appraisals were being completed and staff had been asked to assess their own performance over the past year.
Training had been delivered. Staff told us it was more in-depth and informative than previous training they had received. Staff were knowledgeable about positive behaviour support and had all attended relevant training to enable them to provide appropriate support and understanding to people whose behaviour may, at times, challenge.
Mental capacity and consent was understood. People and their relatives were involved in decision making and assistive technology was being used to support people to communicate. The registered manager had plans to increase the use of technology in the future.
There was a lot of laughter in the service and we observed warm and compassionate relationships between people and staff. Staff were respectful of people and asked permission before sitting with people or providing care and support.
Relatives told us they were more involved with the staff in thinking about activities and goals for their family members. Staff were enthusiastic and motivated to support people to have a presence in the local community. Goal plans were in place to support people to do this.
Staff said they thought the service was well-led. They commented that changes had been made for the better. One staff member said, “We now have a leader.”
A range of audits were completed to identify areas that needed to improve and action plans were developed. The registered manager also had a future planning document which identified actions they wanted to complete over the next 12 months to improve and develop people’s quality of life.
Park Lodge provides care and support for up to eight people who have autistic spectrum conditions. At the time of the inspection there were six people living at Park Lodge all of whom had been placed there from out of area due to the specialist care that could be provided.
Due to the complex needs of people living at the home not everyone was able to share their views about the service with us but we did spend time with people in communal areas observing the care and support they received.
An established registered manager was in post and had been registered since October 2010. They had recently returned to work following a period of absence during which time an acting manager was overseeing the day to day running of the service. 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.
We carried out a scheduled inspection of this service on 10, 16 and 17 September 2014. Breaches of legal requirements were found.
The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. Care and treatment was not always planned and delivered in a way that was intended to ensure peoples safety and welfare. Staff had not received all the training they needed or professional development, supervision and appraisal.
The provider submitted a report detailing the actions they planned to take to meet the legal requirements.
We completed a fully comprehensive inspection of the service on the 29 June 2015. This day was unannounced which meant the provider did not know we would be visiting. A second day of inspection took place on 30 June 2015 and was announced.
We found improvements in relation to staff receiving training in autism, appraisals had been completed and relative surveys had been completed.
We found risk assessments had been completed but they did not always contain sufficient control measures to keep people and their staff safe. Some people diagnosed with epilepsy enjoyed going swimming but we saw no evidence of risk assessments in relation to this activity.
People had a care record titled ‘My Plan’ which included area’s of the person’s life where they needed care and support. We found that this did not always detail specific strategies for staff to follow in relation to specialised equipment and it had not been kept up to date with people’s communication needs or medicine administration.
The review and evaluation of documents had been completed on a monthly basis but the comments stated ‘no change’ or ‘reviewed’ therefore it was unclear whether the plan was still effective and appropriate.
Staff were supporting some people to take medicine in food as it had been recognised that they could not tolerate the taste or texture of specific medicines. Best practice would be for a doctor to authorise this as a best interest decision and for the process to be recorded in a care plan and risk assessment. We saw no evidence that this had been completed.
Health and safety checks were being completed by maintenance staff but they were out of date due to the person’s absence from work. The registered manager thought they were being completed by another person from the maintenance team but had not checked so the fire log book and scheduled maintenance checklists were not up to date.
Deprivation of Liberty Safeguards (DoLS) had been authorised although some had now expired and we saw no evidence that further applications had been made although the registered manager confirmed they had done so. Care staff knew DoLS were in place but weren’t able to explain what it meant for people’s care.
Some best interest decisions were in place but they had not been reviewed. Although staff were seen to act in people’s best interest the process for decision making had not always been followed in line with MCA code of practice.
Staff training was not up to date in relation to the provider’s refresher time periods. This related to mental capacity and deprivation of liberty safeguards. Non-abusive psychological and physical intervention (NAPPI) training was not current. We also saw that staff training in relation to medicine administration was out of date and we saw no evidence of competency based assessments. Makaton training, which some of the people use to communicate, had been mentioned in the provider action plan following the September 2014 inspection but not all staff had received this training.
The provider was not meeting its own aim in relation to supervision as they were not on track to complete six supervisions a year with each staff member. This meant there was no formal process, by way of training and supervision to assess staff competency in relation to meeting the specific needs of the people they supported.
People’s ‘my plan’ was not always kept up to date with changes in people’s care needs. One person’s care manager explained that the person was able to understand verbal communication and they confirmed that staff understood them even though their ‘my plan’ stated their preferred communication method was to use makaton and PECS.
Staff interaction with people was, at times, limited to functional task driven communication. Staff were observed to be having conversations amongst themselves over lunch rather than engaging with the people they were supporting. We also observed staff speaking about people rather than to them.
We saw audit tools were in place but these had not been completed. The registered manager told us they had not had a chance to complete any audits yet. This meant there was no effective and robust system in place to monitor and assess the quality of the service provision.
Safeguarding policies and procedures were in place and staff understood what their responsibility was in relation to reporting concerns. Accidents and incidents were recorded manually and electronically and one person had a behaviour chart which was being used to analyse the impact of a medicine change.
A range of health and safety risk assessments were in place and a fire risk assessment and emergency evacuation plan had recently been updated. Each person had a personal emergency evacuation plan and people were involved in fire drills so they knew what the fire alarm meant.
There were enough staff to meet people’s needs and the registered manager said staffing levels were calculated based on people’s activities. No dependency tool was used and they said there were no contracts in place specifying commissioned hours. One care manager told us one person was funded for five hours of two to one support each day if needed for community activities.
Recruitment was effective with the appropriate level of pre-employment checks in place. The registered manager explained they included people in the recruitment process as prospective staff would come to the service for a meet and greet opportunity and to go out on an activity with people so staff could assess their level of engagement and interaction. This information was then used in the staff selection process.
The staff team were long standing and had a good understanding of behaviour which may challenge. Documentation was in place which described potential triggers for behaviour; a description of the behaviour and how the staff should respond.
Medicines were stored safely and records were completed with double signatures and a senior administration check was completed for each administration. Records were kept when medicine was taken away from the service when people went home for a day or an overnight stay.
Freshly prepared food was on the menu every day and people were supported to have a well-balanced diet.
Health records were in place and seizure monitoring was used to inform meetings with one person’s neurologist.
Activities plans were in place and staff completed a daily record of activities people had engaged in, although we did not see evidence of any analysis of people’s enjoyment of these activities.
A complaints policy and procedure was in place. We could not see an audit trail of how one recent complaint had been managed in relation to the acknowledgement of how the complaint would be addressed and who by.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.
You can see what action we told the provider to take at the back of the full version of the report.
Is the service safe?
We spoke with relatives of people who were using the service. Some relatives were satisfied with the care being provided. One relative told us, "They are very good facilities and very good staff. Everything is fine." Another relative commented, "We feel Park Lodge fulfils all of (our family member's) needs.'
A significant number of relatives were not wholly satisfied with the care provided to their family members, who they felt had a reduced quality of life than previously. This was principally in relation to their daily lifestyles and social activities.
The people who used the service had complex behaviours which meant that they required consistent support and routines, with any changes being carefully planned and handled. We found that risk assessments in relation to people's participation in social activities had remained unchanged over at least two years, despite a range of social activities having stopped because staff said people no longer enjoyed them or their behaviour was too difficult. This meant the service had not clearly established the reasons why staff had experienced problems and had not reviewed the way people were being supported to ensure they were kept safe. It was evident relatives of some people felt there had not been a considered approached to the changes in family member's lives. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.
CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The manager informed us that all six people who were using the service were currently subject to DoLS orders. DoLS are a legal measure under the Mental Capacity Act 2005, which are put in place to ensure that people are looked after in a way that does not unreasonably restrict their freedom.
Is the service effective?
Whilst some relatives were satisfied that staff communicated effectively with their family members, others were not. One told us, 'The staff tell me they are using picture cards, but I've never seen them do this." Another relative had concerns that staff did not use the wide range of communication tools their family member had used in the past and this meant he had not been given information in the most effective way, which would help reduce his anxieties.
People who used the service used different methods of communication, which in the main, were non-verbal. Detailed support plans were in place about their individual methods of communication, but in practice, staff were not using all the methods people preferred, such as the variety of signs one person had previously used and the Picture Exchange Communication System (PECS) they had used in the past. Another person had also used a sensory board, due to their sight impairment, but staff had stopped using this with him. This meant the service was not providing care in the ways described in people's care plans and risk assessments. We have set a compliance action in relation to this.
The provider had identified a range of basic training for staff, which was mainly around health and safety subjects. There were systems in place to make sure this training was updated regularly. However, staff had received little training about autism and about communicating effectively with people who could not communicate verbally. We have set a compliance action in relation to this.
Relatives of four of the six people who were using the service had expressed concerns about their family members putting on weight. We found that advice had been sought about making sure the menu plan was healthy. We found people were supported to eat healthy, balanced diets and there was some evidence people were beginning to lose weight.
Is the service caring?
A relative told us, "It's very caring. They have the interests of people at heart all the time. They try to do their best for residents." Another said, 'I know (my relative) is well looked after.'
We observed that care workers were kind and considerate towards people. We saw that people who used the service were comfortable with the care workers and had good relationships with them. Staff told us they enjoyed their work.
Is the service responsive?
As outlined above, we found that the service had not taken steps to revise and update how people should be supported when concerns had been identified with regard to people's involvement in social activities. In addition, relatives did not always feel they had been sufficiently involved in planning their family members' support.
The service had established basic training requirements for staff, but we concluded there should be a stronger link between the training provided and the needs of people who used the service. For instance, staff had not been given training in using PECS, which one person had used as a method of communication, but which had fallen into disuse.
Is the service well led?
Staff felt supported by the manager and considered that he ran the home in the best interests of the people who were using the service. However, supervision and appraisal had not been carried out effectively. This had been identified through the quality assurance processes in June 2014; however, we found there was still little evidence of progress being made and staff were unclear about the provider's staff support and development system.
There were quality assurance systems in place. However, we considered that these checks were not always effective in identifying concerns or issues. Several people were not being cared for in the ways described in their support plan and this had not been picked up through the quality assurance processes.
Whilst some relatives were very satisfied with their family members' care, others were not. One relative commented, 'They don't tell you anything.' Another relative told us, "I feel there is a communication breakdown. The attitude from the manager is, 'If you don't like the service, you know what you can do. I've said at yearly reviews things, that should have been put in place, that weren't, because of the manager. Things have changed (for the better) recently." Another said, 'I had to go to safeguarding as I was getting nowhere with Park Lodge.'
A compliance action has been set in relation to this and the provider must tell us how they plan to improve.
We viewed all of the private living spaces and the communal areas in the home and found a safe, inviting and friendly atmosphere throughout. There was a large, bright and airy communal lounge that could be used at all times of the day. There was also a large quiet space which people could use whenever they wished and the kitchen had a dining area.
We spoke to five members of staff who all spoke positively and without prompt regarding local management, training and working conditions.
We reviewed the comments and complaints file kept in the office. There had been no complaints in the two years preceding our visit.
We undertook a short observational framework for inspection (SOFI) exercise to observe the interactions between them and the staff. SOFI is designed to be used when inspecting services for people who have some difficulty in communicating their opinions on the services they receive.
During the SOFI, we observed people being offered choices; for example, people were offered a choice of drinks and a choice of meal. Staff were seen to be attentive and gave people the information about the drink and meal options in a way that was appropriate to their needs. One person was supported by staff to put their shoes and coat on prior to them going out to a local pub for lunch. In addition, we observed staff trying to engage people in discussions about the activities they had taken part in that day. We observed staff discreetly speaking to one person when they were showing signs of becoming anxious.