We carried out a review of the data available to us about Haydons 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 Haydons Lodge, you can give feedback on this service.
Haydon's Lodge is a residential care home providing personal care and support to up to 6 people. The service provides support to people with mental health care needs. At the time of our inspection 6 men aged 40 and over were living at the care home. Accommodation is divided into 2 adjoining terrace houses, each with their own adapted facilities and separate entrances with a shared communal garden.
People’s experience of using this service and what we found
Most people received their prescribed medicines as and when they should however, we have made a recommendation about the management of some medicines.
At our last inspection the provider had failed to ensure all the care homes fire-resistant doors were appropriately maintained, personal emergency evacuation plans (PEEP’s) were in place for everyone and their governance systems were effectively managed.
At this inspection we found enough improvement had been made and the provider was no longer in breach of regulation. This was because fire-resistant doors were now appropriately maintained and fit for purpose, up to date PEEP’s were in place for everyone wo lived at the care home and they had introduced electronic governance systems that were operated more effectively.
The feedback we received from people living in the care home and community health care professionals was positive about the standard of care provided at Haydon’s Lodge. A person said, “I like living here…I’m very happy at Haydon’s Lodge.” A community health care professional added, “I have always found the staff at Haydon’s Lodge very professional and responsive.”
Staff understood how to safeguard people. People were cared for and supported by staff who knew how to manage risks they might face. The premises were kept hygienically clean and staff followed current best practice guidelines regarding the prevention and control of infection including, and those associated with testing for COVID-19 and the wearing of personal protective equipment (PPE). The care home was adequately staffed by people whose suitability and fitness to work there had been thoroughly assessed.
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 living at the care home and staff working there were all complimentary about the way the service was managed, and how approachable the managers and staff were. The provider promoted an open and inclusive culture which sought the views of people living at the care home, their relatives, community health and social care professionals and staff. The provider worked in close partnership with various community health and social care professionals and agencies to plan and deliver people's packages of care and support.
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 7 July 2022) and there was a breach of regulation.
Why we inspected
We carried out an unannounced focused inspection of this service on 7 July 2022 when breaches of legal requirements were found. The provider completed an action plan after the last inspection to show us what they would do and by when to improve how they managed fire safety and quality assurance.
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 and well-led, which contain those requirements and issues we discussed with the provider at their last inspection.
We also 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.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
Based on the findings at this inspection we found improvements had been made and the provider was no longer in breach of regulation. The overall rating for the service has therefore changed from requires improvement to good.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Haydon’s Lodge on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 made a recommendation at this inspection in relation to how the provider managed medicines given covertly.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect. If we receive any concerning information, we may inspect sooner.
The care home can accommodate six people in two adjacent terrace houses, which have their own separate entrances, but where facilities are shared. This includes a communal rear garden, two kitchens, two dining areas/conservatory’s and two main lounges.
People’s experience of using this service
Feedback we received from people living in the care home and their relatives was positive about the standard of care and support they or their loved ones were provided at Haydon’s Lodge.
However, we found evidence during our inspection that the provider needed to take action to make improvements.
The service was not always safe. This was because the provider did not always ensure all the risks people might face were properly assessed and manged and not all fire safety equipment was always appropriately maintained. We also signposted the provider to resources to develop their approach to obtaining evidence to show all visitors to the care home did not have COVID-19 or related symptoms.
The service was not always well-managed. This was because the provider did not always operate governance systems effectively and ensure they identified and/or took appropriate action to address all the issues described above in a timely way. The provider also failed to notify the Care Quality Commission (CQC) without delay about the occurrence of a number of incidents that had adversely affected the health and well-being of people living in the care home.
People continued to be supported to stay safe and be protected against the risk of avoidable harm and abuse. People were supported by enough competent staff who knew them well and had been safely recruited. The environment was kept clean. People received their prescribed medicines as and when they should.
Staff had the right levels of training and support they needed to deliver effective care and support to people living at the care home. People had access food and drink that met their dietary needs and wishes. People were helped to stay emotionally and physically healthy and well. 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 lived in a suitably adapted and comfortable care home.
People were treated equally and with compassion, and had their human rights and diversity respected. Staff treated people with respect and dignity and upheld their right to privacy. People were encouraged and supported to maintain and develop their independent living skills. People were encouraged to make decisions about the care and support they received and had their choices respected.
People had up to date person-centred care plans in place, which enabled staff to understand and meet their people's personal, social, emotional and health care needs and wishes. Staff ensured they communicated and shared information with people in a way people could easily understand. People were supported to participate in meaningful recreational activities that reflected their social and cultural interests. People's concerns and complaints were well-managed, and the provider recognised the importance of learning lessons when things went wrong. People were supported to maintain relationships with family and friends. Plans were in place to help people nearing the end of their life receive compassionate palliative care in accordance with their needs and expressed wishes.
People living at the care at home, their relatives and staff working there were all complimentary about the way the registered manager ran the service, and how approachable they were. The provider promoted an open and inclusive culture which sought the views of people, their relatives, community-based professionals and staff. The provider worked in close partnership with various community-based mental health, health and social care professionals and agencies to plan and deliver people's packages of care and support.
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 13 April 2018).
At our last inspection we discussed with the provider concerns we had about chemicals and other substances hazardous to health (COSHH) not being safely stored and faulty window restrictors in people’s bedrooms. The provider responded immediately during and after that inspection and confirmed appropriate action had been taken to improve how they stored COSHH and maintained window restrictions.
At this inspection we found the provider continued to take appropriate action to ensure COSHH were always securely stored away in locked cupboards when they were not in use and window restrictors were in place and well-maintained throughout the care home.
Why we inspected
We undertook this planned inspection based on the previous rating and as part of a random selection of services rated good.
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.
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 two breaches at this inspection in relation to the provider’s failure to always properly assess and manage risks people living in the care home might face and to operate their oversight and scrutiny systems effectively.
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.
The service can accommodate up to six people living with mental health needs. The service is delivered from two adjoining houses that have been separately adapted, each with their own facilities and entrance. People are free to access both houses and all the communal areas are shared including, both the dining areas, lounges, kitchens and the rear garden. At the time of this inspection there were four people aged 60 and over living at the home. [
At our last comprehensive inspection in February 2016 we rated the service ‘Good’ overall and for four out of five of our key questions, “Is the service safe, effective, caring and well-led?” However, we also rated the service ‘Requires Improvement’ for the key question, “Is the service responsive?” This was because people were not always supported do as much as they could do for themselves. At this inspection we found the provider had improved the way they encouraged and supported people to do as much as they could and wanted to do for themselves. This meant people now had greater opportunities to maintain and develop their independent living skills. Consequently, we have improved the service’s rating to ‘Good’ in relation to the key question, “Is the service responsive?”
Furthermore, at this inspection we found the evidence continued to support the overall rating of 'Good' and there was no information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service remains unchanged since our last inspection.
However, the positive points made above notwithstanding we also found during this inspection the service had deteriorated from ‘Good’ to ‘Requires Improvement’ for the key question, “Is the service safe?” This was because substances hazardous to health were not always kept safely stored away when they were not in use and window restrictors in two people’s bedrooms were not well-maintained. These health and safety failures might have put people living in the home at unnecessary risk of harm. We discussed these issues with the registered manager who took immediate action to resolve them at the time of our inspection.
In addition, although recruitment checks for new staff remained robust, the provider did not have any recognised policies and procedures in place to reassess existing staff’s on-going suitability. We discussed this issue with the registered manager who agreed to review the provider’s staff vetting procedures.
The issues we found notwithstanding people living at the home and their relatives told us they continued to be happy with the standard of care and support provided at Haydon’s Lodge. We saw staff still looked after people in a way which was kind and caring. Our discussions with community health and social care professionals supported this.
There continued to be robust procedures in place to safeguard people from harm and abuse. It was clear from comments we received from managers and staff that they were familiar with how to recognise and report abuse and neglect. The provider assessed and managed risks to people’s safety in a way that considered their individual needs and wishes. There were enough staff to keep people safe. The home looked clean and no infection control or food hygiene issues were identified. Medicines were managed safely and people received them as prescribed.
Staff continued to receive appropriate training to ensure they had the right knowledge and skills needed to perform their roles effectively. People were supported to eat and drink enough to meet their dietary needs. People said they liked the quality and choice of meals they were offered at the home. Managers and staff were aware of their duties under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff sought people's consent before providing any care and support and followed legal requirements when people did not have the capacity to do so. They also received the support they needed to stay physically and emotionally healthy and well. People also had access to the relevant community based physical health care and mental health services.
Staff continued to provide personalised care to people that was tailored to their individual needs and wishes. Each person had an up to date and person centred care and recovery plan, which set out how their care and support needs should be met by staff. These were routinely reviewed and updated by staff. Staff were knowledgeable about people’s backgrounds and cultural heritage. People continued to be supported to participate in a wide range of individual and group activities at home and in the wider community that met their social interests and wishes. People continued to be supported to build and maintain friendships and relationships with people that mattered to them. People were supported to maintain maximum control over their lives and staff supported them in the least restrictive way possible. The policies and systems the service had in place supported this practice. When people were nearing the end of their life, they received compassionate and supportive care.
People and relative’s felt comfortable raising any issues they might have about the home with managers and staff. The service had arrangements in place to deal with people’s concerns and complaints appropriately. The provider routinely gathered feedback from people living in the home, their relatives and staff. The provider also worked in close partnership with external health and social professionals and bodies. It was evident from the registered manager’s comments they understood their registration responsibilities particularly with regards to submission of statutory notifications about key events that occurred at the service.
Further information is in the detailed findings below.
Hayden’s Lodge provides accommodation, care and support to up to six adults with mental health needs and/or learning disabilities. The service is delivered from two residential homes in South London. People are free to access both homes and they share communal areas and gardens. At the time of our inspection five people were using the service.
The service had 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.
People were involved in decisions about their care and chose how they spent their time. A key worker system was in place to provide people with one to one support, and to have regular discussion with people about working towards the goals in their recovery plan. People were supported to develop some of their daily living skills. However, staff were not adequately supporting people to develop independent living skills and were not motivating and stimulating people to engage in meaningful activities.
People received the support they required to stay safe and well. Staff were aware of the risks to people’s safety and to the safety of others. Staff worked with people to manage and minimise those risks. Risk management plans were in place and regularly reviewed.
Staff supported people with their mental and physical health needs. Staff liaised with the healthcare professionals involved in people’s care and the community mental health team to identify people’s health needs. Staff discussed with them any changes in people’s behaviour. Recovery and support plans were in place which identified what support people required and how this was to be delivered.
People received the care they required with their health and were supported to access the GP when they needed them. Staff discussed with people how their health could be promoted, including informing them about foods appropriate to their dietary requirements.
People received their medicines as prescribed, and safe medicines management processes were followed. Clinical waste was stored and disposed of safely.
Staff had the knowledge and skills to support people, and this was regularly updated through the completion of training sessions. Staff’s competency was reviewed during supervision and appraisal processes. The registered manager supported staff to develop, including supporting them to complete additional relevant qualifications.
Staff were aware of the procedures to follow if they had concerns about a person’s health, witnessed an incident or had concerns a person was being harmed. The registered manager reviewed any concerns identified and liaised with health and social care professionals when appropriate to ensure people received the support they required.
People, their relatives and staff were able to express their views and opinions about the service. There was open communication amongst the staff team and with the people using the service. Meetings were held with people and staff to obtain their feedback about the service. The registered manager investigated any complaints received and took the necessary action to address the concerns.
The registered manager regularly reviewed the quality of service provision. This included reviewing the quality of the support provided to people, the support staff received, and ensuring a safe and secure environment was provided.
The registered manager took the necessary action to address the previous breaches of legal requirements. Statutory notifications were submitted of significant events that occurred at the service, and they provided information we requested in a timely manner.
This inspection took place on 20 November 2014 and was unannounced. At the last inspection on 16 July 2013 we found the service was meeting the regulations we looked at.
Haydons Lodge is a small care home which provides accommodation for up to six adults with mental health needs and/or a learning disability. The accommodation is split across two adjoining houses, each with their own separate entrance. Each house accommodates three people. At the time of our inspection there were six people living at the home. Each person has their own room. In each house there are communal facilities such as a lounge, dining room, kitchen and garden. People are free to use the communal areas in both houses.
The service had a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.
During this inspection we found the service had not ensured a medicine prescribed to an individual was safe to use. However all other medicines were stored safely, and people received their medicines as prescribed.
We recommend that the provider considers guidelines issued by the National Institute for Health and Care Excellence (NICE) in March 2014 for managing medicines in care homes.
We found inappropriate arrangements in place for the disposal of insulin pens which increased the risks of the spread of infection. However the home was clean and tidy throughout and free from malodours.
People and their relatives told us people were safe at Haydons Lodge. Staff knew how to protect people if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise and manage these to keep people safe from harm or injury in the home and community. The home, and the equipment within it, was regularly checked to ensure it was safe. The home was clear and free of clutter to enable people to move safely around the home. There were enough suitable staff to care for and support people.
People’s needs were met by staff who received appropriate training and support. Staff felt well supported by the manager. Staff looked after people in a way which was kind, caring and respectful. They had a good understanding of people’s needs and how these should be met.
Staff supported people to keep healthy and well through regular monitoring of their general health and wellbeing. People were encouraged to drink and eat sufficient amounts. Where there were any issues or concerns about a person’s health or wellbeing staff ensured they received prompt care and attention from appropriate healthcare professionals.
Care plans were in place which reflected people’s specific needs and their individual choices and beliefs for how they lived their lives. People were appropriately supported by staff to make decisions about their care and support needs. These were reviewed with them regularly by staff.
The home was open and welcoming to visitors and relatives. People were encouraged to maintain relationships that were important to them. People were also supported to undertake activities and outings of their choosing. People and their relatives told us they felt comfortable raising any concerns they had with staff and knew how to make a complaint if needed.
During this inspection we found the provider in breach of their legal requirement to submit notifications to CQC. We also found they had failed to submit to CQC, written information about the service, which they had been required to do. You can see what action we told the provider to take at the back of the full version of the report.
The systems in place to monitor the safety and quality of the service were not always used effectively. We found checks of medicines in the home failed to identify some issues and concerns in the way these were managed.
The provider regularly sought people’s views about how the care and support they received could be improved. They also engaged with other social care providers to identify best practice used elsewhere, to make improvements within the home.
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The provider sent us an action plan on 30 April 2013 setting out the actions they would take to achieve compliance with these regulations. During this inspection we checked these actions had been completed.
We were unable to speak to people using the service during our visit. We gathered evidence of people's experiences of the service by speaking with staff and reviewing other records related to the running of the service. From minutes of residents meetings we saw people were generally satisfied with the care and support they received.
From people's records we saw plans were in place to meet their care and support needs. Risks to their health, safety and wellbeing had actions identified to manage these. We saw records had been reviewed and updated so that staff had up to date information about people's current care and support needs.
Appropriate arrangements were in place for obtaining, recording, and handling medicines. Medicines were administered appropriately and stored safely.
The provider had taken steps to make improvements to ensure the home was adequately maintained.
The provider did not have a consistent approach to the care planning process. Some support and recovery plans did not have dates and were not signed by staff or by people using the service to show their involvement in this process. We also found some plans were dated more than a year ago so it was not clear when these had been reviewed.
People were seen by healthcare professionals but records were not always kept about the outcomes of the appointment and when these took place. Staff therefore might not have had the necessary information to fully support people with their healthcare needs. Medicines were not always managed appropriately to ensure people were protected against the risks that could arise from medicines.
People lived in a homely environment but the premises were not adequately maintained to ensure they lived in a pleasant environment. Living areas were used for storage and some cleaning products were not stored securely to ensure the safety of people.
Staff were appropriately supported to ensure they were sufficiently skilled to care and support people who use the service.
'I like the food' and 'I get the food I like' were some of the comments about the food provided. People told us they make themselves drinks when they want.
General comments about the staff included 'the manager is good, she listens and helps', 'staff listen' and 'they're alright'.