Franklyn Lodge 9 Grand Avenue

Franklyn Lodge 9 Grand Avenue is a care home providing residential care to 6 people with learning disabilities.

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 the Care Quality Commission (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:

Some staff worked long hours without an appropriate rest break before their next shift. People were cared for by staff who had been recruited and employed after appropriate checks had been completed. We found that there were gaps in staff training and it was not clear if training had been completed by some staff. There were systems in place to minimise the risk of infection. Medicines were managed effectively. 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:

There was a calm and relaxed atmosphere in the service. People received kind and compassionate care. Staff protected and respected people's privacy and dignity. Care and treatment was planned and delivered in a way which focused on people’s individual needs. People were supported to help achieve their goals and aspirations by a staff team who knew them well. However, it was not always evident that people were supported to engage in activities that enabled them to develop their skills. Communication was either verbal or through observing people's reactions to suggestions or actions.

Right Culture:

The service had made some improvements to their quality assurance system since the previous inspection. However, we found that there were still some areas that needed to be addressed and were not assured that quality assurance systems were sufficiently robust. The registered manager promoted a culture in the home where staff valued people's individuality and protected their rights. Staff were responsive to people’s needs and wishes. Staff and family members spoke positively about the management of the service. The staff turnover at the service was low, which helped ensure people received consistent care from staff who knew them well.

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 requires improvement (published 7 May 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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 and recommendations

We have identified 1 breach of regulation in relation to quality assurance at this inspection. We have also made a recommendation in relation to staffing, staff training and activities.

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.

Franklyn Lodge 9 Grand Avenue provides accommodation and personal care for a maximum of six adults who have learning disabilities. The home is a detached house. It is close to shops and transport links. At the time of our visit, there were six people living in the home. .

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. The service provided people with planned and co-ordinated person-centred support that was appropriate and inclusive for them.

People’s experience of using this service

People were unable to provide us with verbal feedback because they had complex needs. Three of them nodded and smiled when we asked them if they were happy in the home. A relative and two care professionals informed us that staff treated people with respect and dignity and people were safe in the home. We observed that staff interacted well with people and were attentive towards them. Staff made efforts to ensure that people's individual needs and preferences were responded to.

Most risks to people’s health and wellbeing had been assessed and documented. There was guidance for staff on how to minimise risks to people. We noted that there was no risk assessment for a person with diabetes. This was needed to ensure that potential risks could be minimised. The completed risk assessment was sent to us soon after the inspection. Personal emergency evacuation plans (PEEPs) were in place for two people. Window restrictors were not in place in one bedroom while three other bedrooms had restrictors that were too wide. These were rectified on the second day of inspection.

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

People had received their medicines as prescribed. The home had suitable arrangements for the administration of medicines. No unexplained gaps were noted in the medicines administration records (MAR) examined.

Staff had been carefully recruited and essential pre-employment checks had been carried out. The home had adequate staffing levels. We noted that a staff member had worked long hours with only a short break of six hours over a two-day period. This may place people at risk since the staff member may not have sufficient rest. The registered manager agreed that in future staff would not be working long hours. We have recommended that the arrangements for staff working hours be reviewed.

Staff were supported to care for people. They had received training and had the knowledge and skills to support people. They had regular supervision and a yearly appraisal of their performance.

The premises were mostly clean and tidy. One window sill was dirty. The registered manager explained that colour from a person’s wet colouring box had been left there and this may have coloured the window sill. The area around another bedroom sink was dirty. On the second day of inspection these areas were found to have been cleaned.

There was a record of essential maintenance carried out by specialist contractors. Fire safety arrangements were in place. The home had responded to recommendations made by the fire service. The names of staff and people present were not recorded. The registered manager agreed to record them in the future.

Management monitored the quality of the services via regular audits and checks. We however, noted that some aspects of the service were not well managed. A number of deficiencies were noted by us and we have made a recommendation in respect of this deficiency in the Well Led section of this report.

Staff supported people to have a healthy and nutritious diet that was in line with their individual dietary needs and preferences. The healthcare needs of people had been attended to. People could access the services of healthcare professionals when needed.

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.

People’s care needs had been assessed prior to them coming to the home and staff were knowledgeable regarding these needs. The service provided people with person-centred care and support that met their individual needs and choices.

The service had a policy on ensuring equality and valuing diversity. People’s diverse needs had been assessed and action taken to meet those needs.

The service was committed to encouraging people to be as independent as possible. Staff supported people to participate in various activities within the home and in the community. Feedback we received from people’s representatives indicated that staff had assisted people to settle down and make progress in their social skills.

There was a complaints procedure and relatives knew how to complain. Complaints made had been recorded and promptly responded to.

There was a record of accidents and incidents. Guidance to prevent re-occurrence was provided when appropriate.

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 29 August 2017).

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

During the inspection, the registered manager was not available. However the home was being managed by the acting deputy manager. The acting deputy manager was being supported by the provider who regularly visited the home.

At the last inspection on 12 June 2015 the service was rated Good.

At this inspection we found the service remained Good.

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 and were updated when people's needs changed.

Relatives informed us that they were satisfied with the care and services provided.

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. Bedrooms had been personalised with people's belongings to assist people to feel at home.

Staff had been carefully recruited and provided with 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.

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 people’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 about people and the service, and had an opportunity to share good practice and any concerns at these meetings.

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 four 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 not able to tell us their experiences.

We observed the care provided and the interaction between staff and people who used the service. We also spoke with two care staff and the Registered Manager. 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 were trained 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 their relative was 'always happy' and another relative commented their relative 'is very happy at Franklyn Lodge and the staff are very kind and considerate towards them'.

We saw people being treated with respect and dignity. Staff communicated well with people and explained what they were doing and why. We observed people were supported to make choices and were given a choice by staff and asked what they wanted to do. During the inspection, we observed people who used the service were relaxed and seemed happy.

Is the service responsive?

We saw the home had a complaints policy and procedure in place which was easily accessible to staff and people who used the service. We found staff were aware of how to make a complaint and felt comfortable approaching the manager with any concerns they had.

We also found regular reviews were being held between people who used the service, their family or representatives, the Registered Manager and Director of Services, where all aspects of their care were discussed and any changes 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 which showed good feedback had been received.

There were regular consultations and resident meetings with the people who used the service which gave them the opportunity to relay any issues or concerns they had and if they had any complaints they wished to make.

We also found 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.

We found 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 had also being 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 supported and interacted with people who used the service in a gentle manner. Plans of care addressed the diverse needs of people who used the service. The healthcare needs of people who used the service had been attended to.

Staff had consulted with people who used the service and their representatives to ensure that the care provided was appropriate and their preferences were respected. There were suitable arrangements in place to manage medicines. Arrangements were in place for the prevention and control of infections and staff had been provided with relevant training.

The home had a policy on confidentiality. Records were well maintained and kept securely locked when not in use.

We observed that people who use the service appeared well cared for and were dressed appropriately. Staff supported and interacted with people who use the service in a gentle manner. Plans of care had been prepared which were holistic and addressed the needs of people who use the service. The healthcare needs of people who use the service had been attended to and details of appointments with healthcare professionals had been documented.

Arrangements were in place to ensure that people who use the service were protected from abuse. People felt safe and staff were vigilant in ensuring that people who use the service were kept safe.

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.