Franklyn Lodge

Franklyn Lodge is a care home which provides accommodation and personal care for a maximum of nine adults who have autism and learning disabilities. At the time of this inspection, there were nine people using the service.

We found the following examples of good practice.

• The service ensured that visitors to the home were carefully screened so that they do not present a risk to people in the home. Their temperatures were checked at the door. Personal protective equipment (PPE) including face masks, disposable gloves and aprons were provided for visitors before they entered the home. Social distancing was observed. This was aimed at preventing and controlling the spread of infection.

• Staff had a good understanding of infection prevention and control measures. They had been provided with infection control training and regular updates. The home had enough and appropriate PPEs. Staff changed into their working clothes at the home before starting their work, they then changed out of their uniforms before leaving the home.

• The home provided a taxi service when necessary. This was to reduce the risk associated with travel on public transport.

• There was a COVID-19 infection control handbook. It was in a simple and pictorial format so that people could easily understand it.

• Posters and guidance regarding infection prevention and control were on display at the entrance of the home.

Franklyn Lodge is a care home which provides accommodation and personal care for a maximum of nine adults who have autism and learning disabilities. At the time of this inspection, there were nine people using the service.

The service had been developed taking into account best practice guidance and the principles and values underpinning Registering the Right Support (RRS). The service had mitigated against environmental factors that would otherwise make the environment feel institutional. For example, there were deliberately no identifying signs, intercom, cameras or anything else outside to indicate it was a care home.

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

Quality assurance systems had not been used effectively to identify concerns we identified during this inspection. We found no evidence people had been harmed, however, systems were either not in place or robust enough to demonstrate safety was effectively managed. Mainly, we found the culture at the service did not promote person centred care. This was evident across all areas where we identified shortfalls.

The service did not apply the full range of the principles and values of RRS and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people did not fully reflect the principles and values of RRS for the following reasons. We found people followed a set of generic routines, which was not consistent with person centred care.

People were not always protected from potential harm. Risk assessments for people with behaviours that challenged the service did not follow positive behaviour support approaches. PBS is a person-centred approach, recommended to support people with learning disabilities who display behaviours that challenge. The risk assessments did not identify specific factors that contributed to people’s behaviours. There was a risk that staff could miss specific triggers and would not be able to support the person fully to minimise the likelihood of the behaviour happening in the first instance.

Staff were not deployed effectively. From the records reviewed, it was not clear how many staff were scheduled to work per shift. We noted irregularities as staff who were rostered to work, were not the same as those completing the handover records on the specified dates. The irregularities in deployment of staff meant we could not be assured that people’s needs were being sufficiently met.

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 26 June 2019).

Why we inspected

We received concerns in relation to staffing, quality of risk assessments and person centred care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Franklyn Lodge is a care home which provides accommodation and personal care for a maximum of nine adults who have autism and learning disabilities. At the time of this inspection, there were nine people using the service.

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. The service worked towards the goal of enabling people with learning disabilities to live as ordinary a life as any citizen.

People’s experience of using this service:

People using the service had complex needs and they were unable to provide us with confirmation regarding the care provided. However, they appeared comfortable and well cared for. They interacted well with staff and there was a relaxed and homely atmosphere. People’s relatives were positive about the care provided by staff and said that they treated people with respect and dignity.

Risk assessments had been documented. Risks to people’s health and wellbeing were regularly assessed.

There were regular checks related to maintenance of the premises, health and safety, staffing arrangements and management of accidents and incidents. Staff informed us that they checked the hot water temperatures prior to people having a shower.

Staff had received training on how to safeguard people and were aware of the procedure to follow if they suspect that people were subject to abuse

The home had a policy and procedure to ensure that people received their prescribed medicines. Staff had received medicines administration training and knew how to administer medicines safely. We however, noted that the temperature of the room where medicines were stored had been over 30 degrees centigrade for the past seven days. Such high temperatures of over 25 degrees centigrade may affect the potency of medicines administered to people. Immediate action was taken by the service to rectify this after the inspection.

The home had adequate staffing levels and staff were able to attend to people’s needs. This was also confirmed by staff and most relatives.

People were supported to live a healthy life. Staff supported people to have a healthy and nutritious diet that was in line with their individual dietary needs and preferences. People had access to healthcare professionals when needed.

The service worked towards ensuring that people received personalised care and support that met their individual needs and choices. Care documentation included details about people’s individual needs and preferences. People’s care had been reviewed with them and their representatives to ensure they met their changing needs.

Staff received appropriate training to ensure they had the right knowledge and skills to support people in a safe and effective way. The registered manager and senior staff supported care workers by providing them with regular supervision and a yearly appraisal of their performance.

Staff knew people well and had a caring approach to their work. They understood the importance of treating people with dignity, protecting people's privacy and respecting their differences and human rights. Positive caring relationships had developed between people who used the service and care workers.

People appeared comfortable in their environment. We however, noted that some areas of the home needed repairs and redecoration. We were informed after the inspection that an item of furniture in need of repair had now been replaced and redecoration had been competed for an area of the home identified by us.

Staff understood their obligations regarding the Mental Capacity Act 2005 (MCA). 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 supported this practice. Staff gained people's agreement before providing them with assistance with personal care and other activities.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person's best interests. The home had made necessary applications for DoLS where people’s liberty needed to be restricted for their own safety.

Staff supported people to actively participate in activities and pursue their interests. People were seen going out to participate in activities.

There was a formal complaints procedure in place which was available to people and their representatives.

The home had a management structure in place with a team of care support workers, a deputy manager and the registered manager. The morale within the home was good and staff worked well with one another. Staff felt supported by their managers.

Management monitored the quality of the service and we saw evidence that regular audits and checks had been carried out to improve the service. These included areas such as care documentation, health and safety, cleanliness of the premises and medicines management and staff training.

Rating at last inspection: The service had been inspected on 17 November 2016 and rated as Good.

Why we inspected: This was a scheduled planned comprehensive inspection.

Follow up: We will continue to monitor the service through the information we receive.

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

There was 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People's health and social care needs had been appropriately assessed. Care plans were person-centred, and specific to each person and their needs. Care preferences were documented and staff we spoke with were aware of people's likes and dislikes. Care plans were reviewed monthly and were updated when people's needs changed.

Relatives informed us that they were satisfied with the care and services provided. Relatives also told us that they were confident that people were safe in the home.

Systems and processes were in place to help protect people from the risk of harm. Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

We found the premises were clean and tidy. There was a record of essential maintenance carried out at the home. Bedrooms had been personalised with people's belongings to assist people to feel at home.

Staff had been carefully recruited and provided with induction and training to enable them to support people effectively. They had the necessary support, supervision and appraisals from management.

Staff we spoke with had an understanding of the principles of the Mental Capacity Act (MCA 2005). Capacity to make specific decisions was recorded in people's care plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had made necessary applications for DoLS as it was recognised that there were areas of the person’s care in which the person’s liberties were being deprived. Records showed that the relevant authorisations had been granted and were in place.

There were suitable arrangements for the provision of food to ensure that people's dietary needs were met.

Staff were informed of changes occurring within the home through daily handovers and staff meetings. Staff told us that they received up to date information and had an opportunity to share good practice and any concerns they had at these meetings.

There was a management structure in place with a team of care workers, registered manager and the provider. Staff spoke positively about working at the home. They told us management were approachable and the service had an open and transparent culture. There were systems in place to monitor and improve the quality of the service.

At the time of our inspection, the home was providing care for five people.

We used a number of different methods to help us understand the experiences of people who used the service, because people who used the service had complex needs which meant they were only able to communicate using key words, body language, gestures, facial expressions and objects of reference.

We observed the care provided and the interaction between staff and people who used the service. We also spoke with three care staff, the Registered Manager and Director of Services. We also read feedback from relatives.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who used the service had support plans and risk assessments which helped to ensure their safety and welfare.

We found the home had safeguarding, whistle blowing and Deprivation of Liberty Safeguards (DoLS) policies and guidance in place. Training records showed staff had received training in safeguarding and DoLS. When speaking to them, they were able to provide examples of what constituted abuse and how they could identify abuse. They were aware of action to take and how to report allegations or incidents of abuse to the relevant authorities.

The Care Quality Commission (CQC) monitors the operation of the DoLS which applies to care homes. While no applications have been submitted, appropriate policies and procedures were in place. When speaking with staff we found they had an understanding of the Mental Capacity Act (MCA) 2005 and the DoLS and how it applied to the people they were providing care and support to on a daily basis.

Is the service effective?

We found the home had taken steps to ensure that people were included and involved as much as possible in their care and support. We found they used various methods of communication to engage and involve people who used the service as much as possible such as pictures, facial expressions, sign language, key objects and words and simple Makaton signs.

We looked at four care plans and saw that people's needs had been assessed and care and treatment were planned and delivered in line with their individual care plan. Risk assessments had been carried out. We found these were person-centred, detailed and specific to each person and their needs.

Although the care plans included information about people's mental state and cognition, we saw no evidence that mental capacity assessments had been carried out. We raised this with the Registered Manager and they confirmed they would carry out a mental capacity assessment for each person in the home.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Staff received training in areas of relevance to their job roles and demonstrated knowledge of people's individual needs and requirements.

Is the service caring?

We found good feedback had been received about the home. Feedback from one relative read 'Thank you for the inclusion in the family review meeting. I can honestly say that the care and attention given to [relative] is excellent. [Relative] is always happy and attentive when we meet. Thanks to you and their carer for supporting [relative] to lead an enjoyable and fulfilled life'.

We saw people treated with respect and dignity. Staff communicated well with people and explained what they were doing and why. We observed staff supporting people to make choices and staff asked people what they wanted to do. During the inspection we observed that people who used the service were relaxed and happy.

Is the service responsive?

We found that regular reviews of each person's support and care needs took place. The reviews involved people who used the service, their family or representatives, the Registered Manager and Director of Services. The reviews included discussion of all aspects of each person's care and any changes were actioned if required.

People's health and medical needs were assessed and we viewed records demonstrating that they were supported and had access to health and medical services when necessary.

Is the service well-led?

We found the home had a system in place to obtain feedback through surveys. There were regular consultations and resident meetings with the people who used the service. These gave people the opportunity to relay any issues or concerns they had and to raise any complaints they wished to make.

We also found that regular monthly staff meetings took place which ensured staff had the opportunity to communicate their views about the service and to discuss the care and support needs of people who used the service.

The home had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others. Checks were also conducted on all electrical equipment and maintenance checks and service records were up to date.

We observed that people who used the service appeared well cared for and were dressed appropriately. Staff were noted to be constantly supervising and interacting with people who used the service in a friendly manner. Plans of care had been prepared for people following consultation with people and their representatives. There were appropriate arrangements in place to manage medicines.

The bedrooms and the communal areas had been kept clean and tidy. The home had a record of essential maintenance and safety inspections carried out. Fire safety measures were in place.

The home had a recruitment procedure. The necessary staff recruitment checks had been carried out and staff we spoke with were knowledgeable regarding their roles and responsibilities.

The home had a complaints procedure. Complaints made had been promptly responded to.