Preceptory Lodge

Updated 24 November 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector, a medicines inspector and an Expert by Experience.

An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Preceptory Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Preceptory Lodge is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke to the registered manager, deputy manager, one staff member and two people who lived at the service as part of the inspection. We reviewed a range of records. This included two peoples care records and multiple medication records. We looked at three staff files in relation to recruitment and supervisions and a variety of records relating to the management of the service.

After the inspection

We spoke to six relatives, two people who lived at the service and three staff members. We looked at policies and procedures and quality assurance records. We continued to seek clarification from the provider to validate evidence found.

Updated 24 November 2022

About the service

Preceptory Lodge is a small residential care home providing personal care for up to 8 people with autistic spectrum disorder or learning disabilities. At the time of the inspection there were 6 people living in the service, two in the bungalow and four in the main house.

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: Staffing difficulties meant that some people did not always have the correct support available to them. We did not find that any harm had come to the people from this concern, however, the lack of staffing in the service increased the risk of harm. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome. However, records did not always reflect best practice guidance. We made a recommendation about this. The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. Safety checks were taking place on the emergency equipment; however, more work was needed to ensure all fire safety precautions were in place. We made a recommendation about this. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. 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.

Right Care: Staff understood people’s needs however, the service did not always ensure their training was up to date and that their competency in administering medication was reviewed. Staff told us they felt well trained and supported by the senior management team however, the delay in refresher training increased the chances of poor practice. Support plans were in place to help guide staff on how to care for people. These records reflected people’s preferences however, some areas needed updating and expanding to ensure they fully reflected the people’s range of needs. 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 and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

People and their relatives told us they were happy with the care provided by the service, one relative said, “I feel fortunate [Person] is there, it’s like going to someone’s home, very homely and [Person] seems happy.”

Right Culture: Quality systems had been developed to review and monitor the care in the service however, these failed to highlight some of the concerns raised from the inspection. The management team promoted an open culture, which supported learning lessons from when things went wrong, but records did not always reflect this. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity. 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.

Staff told us they felt well supported in their roles and found the management team approachable. They would not hesitate to raise concerns and discuss ways on how to improve the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 December 2021) and there were 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 we found the provider remained in breach of regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 13 October 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the safety and governance of the service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains as requires improvement. 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 Preceptory Lodge on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the staffing and the governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.