May Lodge

May Lodge is a residential care home providing regulated activities of accommodation and personal care for up to 6 people. The service provides support to people who have a learning disability and/or autistic people At the time of our inspection there were 6 people using the service.

May Lodge supports 1 person in their own self-contained flat attached to the main bungalow. The other 5 people have their own bedrooms with their own bathrooms. May Lodge is situated on the same grounds as another care home May Morning, which is under a separate registration.

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 by staff to pursue their interests and staff supported people to achieve their aspirations and goals. 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. 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.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. People’s relatives told us that the staff were very knowledgeable and caring. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. Relatives told us they felt their loves one was safe at the service.

Right Culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. 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. People and those important to them, including advocates, were involved in planning their care.

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 good (published 05 September 2017).

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.

The inspection was prompted in part due to concerns received about safeguarding. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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.

Staff followed government guidance in relation to wearing personal protective equipment (PPE) such as masks, gloves and aprons. Staff were able to dispose of used PPE safely in the home.

The provider ensured all people and staff were following government guidance in relation to COVID19 testing.

The registered manager and staff ensured residents were able to stay in contact with friends and family when government visiting restrictions were in place for care homes.

The registered manager and staff ensured all visitors entering the home followed their COVID19 policy, including wearing PPE and providing a negative lateral flow test.

Our last inspection in August 2016 found five breaches of our regulations and an overall rating of requires improvement was given. This was because there were concerns in respect of risk assessment and effective quality assurance. We also highlighted that improvements were needed in respect of medicines management, restrictions to a person’s liberty and staff training. The provider sent us an action plan which told us how they would improve and when this work would be completed. At this inspection we found that all these issues had been addressed.

There was a new registered manager in post. A registered manager is a person who is 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 registered manager was present throughout the inspection.

The environment was well maintained although some improvements were needed to improve safety in the garden. Fire prevention and other equipment and installations were routinely serviced, checked and tested. Staff received fire training and plans were in place to ensure all staff participated in fire drills.

Staff had received training to recognise and act upon suspected abuse. Incidents and accidents were appropriately managed and analysed for trends. There was a robust staff recruitment process in place. New staff were inducted into their role and all staff received appropriate training. Staff felt supported and listened to, and received regular opportunities to express their views and discuss their training and development needs with their line manager. There were sufficient staff on duty at all times to meet people’s needs.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005, and Deprivation of Liberty safeguards and what this meant for the people they supported.

Staff understood people’s food likes and dislikes and developed menus that took account of individual preferences and special dietary needs. Alternatives to the menu were available for people and snacks and drinks were provided in between meals. Any nutrition and hydration risks were addressed with health professionals. People had individualised plans of care and support about which they and their relatives were consulted. People‘s health needs were met.

Staff demonstrated they knew people well. Staff were respectful to people and treated them with dignity and kindness. Staff showed they had a good understanding of people’s individual characters and provided support in a person centred way. People’s social needs were met. Staff communicated effectively with people and understood when they were unhappy about aspects of the service they received.

The provider had a quality monitoring system in place. A range of audits were in place to provide assurance that all aspects of service quality were being monitored and shortfalls acted upon to ensure people’s safety.

At our previous inspection of this service in February 2016 we found the service was not meeting the required standards of quality, safety and personalisation of care and support to the person living there at that time and there were significant shortfalls, the service was placed into special measures. We took enforcement action against the provider and asked them to tell us what they were going to do to put the shortfalls right. Since that time the provider has kept us informed regularly of progress they have made towards meeting the required standards. This inspection was to assess whether the improvements they had told us about had been embedded and were now everyday practice.

At the time of our inspection a second person had been admitted within the past week and a third had been assessed and was commencing transition to move to the service. People were unable to tell us about their experience of care but when we met them they were relaxed in the company of staff and in good moods. A relative spoke positively about the quality and delivery of care provided by staff to their family member.

A registered manager had not been in post since December 2015, although there was an on-going recruitment for this. A registered manager is a person who is 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.

Our inspection highlighted that whilst there had been significant progress made there were still shortfalls that needed further work to evidence they fully met the requirements of some regulations. The use of medicines in the service had been minimal with an occasional ‘as required’ medicine used, however with the admission of more people there was now a need for staff to administer prescribed medicines and we noted some shortfalls within the current system that needed to be attended to. A framework was in place for the assessment of both individual and environmental risks to ensure people were kept safe but there were some risks that had still to be assessed and this could place people at risk of harm.

People referred to the service were assessed prior to admission and a programme of transition implemented to enable them to familiarise themselves with the new service; some key information however, had still not been sufficiently detailed about people’s needs and this left staff still asking questions in relation to needs and support around this. Staff said access to training had improved but some important relevant courses were still outstanding for some staff.

Quality audits were in place but not always carried out robustly or evidenced clearly that actions had been taken to provide assurance that the service was meeting standards.

Staff had an understanding and awareness of the Mental Capacity Act, capacity assessments were being undertaken but staff did not recognise that some of their practice could be considered as restrictive and should be discussed within a best interest discussion. Staff respected people’s choices but there was a risk their privacy could be compromised without appropriate equipment to alert them to the presence of others. A lack of skilled communication by staff could lead to isolation for some people. People were consulted about their menu choices but there was some repetition in the meals provided to them on some weeks.

Incidents of behaviour which challenged were assessed and trends and patterns informed the development of guidance and strategies for staff, however these were overdue and staff still lacked confidence in managing incidents that were very challenging at times.

There were enough staff to keep people safe and the number of staff would increase as new people were admitted. Recruitment procedures ensured that appropriate checks were made of prospective staff in accordance with requirements of the legislation. Staff said that the improved interim management arrangements made them feel better supported and more confident when issues arose that they wanted or needed guidance and support with. They had regular opportunities through staff meetings and individual supervisions to express their views and receive support around their training and development. New staff received induction and were registered for the care certificate but still to commence this. Staff had not been in post long enough to have their performance appraised but new staff experienced a probationary period when they met with a member of the interim management team to discuss their progress.

There had been no complaints and relatives told us they felt confident of making a complaint should they need to do so. The complaints procedure was clearly displayed within the service and an easy read version available, the provider recognised this needed further revision to meet the needs of people in this service.

A comprehensive care plan had been developed to inform staff how to provide support to people in accordance with their needs and wishes. Improvements had been made to range of activities provided to people and transport was available to enable them to go out into the community; each person was provided with an individualised activity schedule that reflected their interests.

The premises were well maintained a maintenance team provided appropriate support for repairs and servicing checks and tests of equipment were completed within timescales. Fire procedures and evacuation plans were understood by staff and they understood how to protect people from harm and keep them safe, but we have recommended discussion around personal evacuation plans with the fire service. Peoples general health needs were supported and appropriate referrals made to health professionals for support and advice.

Peoples relatives were made welcome and people were supported to maintain contact with important people in their lives. Relatives felt informed.

Updated policies and procedures were in place and staff had been asked to read and sign that they had read those relevant to their role and support of people. The management staff understood their responsibilities to alert the Care Quality Commission to events in the service but had not had to do so to date.

People were supported and enabled to develop independence skills. They were supported to personalise their own space. Key workers spent time with people to try and engage with them and listen to what they had to say or sign to them.

As this service is no longer rated as inadequate, it will be taken out of special measures. Although we acknowledge that this is an improving service, there are still areas which need to be addressed to ensure people's health, safety and well-being is protected. We identified a number of continued breaches of Regulations. We will continue to monitor May Lodge to check that improvements continue and are sustained.

We have made three recommendations:

We recommend that the provider seek advice from the fire service on the appropriateness of personal evacuation plans in respect of people being left behind fire doors in the event of a refusal to leave.

We recommend that the provider seek advice from a competent source regarding appropriate doorbell systems for hearing impaired people.

We recommend that the provider seek guidance from a competent source on the development of a suitable, appropriate and accessible complaints format for people with complex needs and very limited verbal skills.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This service was last inspected in September 2013 when we found the provider was meeting all the requirements of the legislation.

At this inspection there was not a registered manager in post: the previous manager ceased to be the registered manager for the service from 11 December 2015. Interim management cover arrangements from within the organisation had lacked continuity and been ineffective. 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.

There had been a lack of preparation for the opening of the service and the support of the only person currently admitted. The person accommodated could be placed at risk because although staff had received their basic essential training to undertake their role, they had not received additional specialist training in regard to the person’s method of communication, their moving and handling needs. Staff had been provided with training to support people whose behaviour could be challenging, but, an individual behaviour management strategy had not been developed and implemented for the service user to ensure support around behaviour was consistent.

Risks were not appropriately assessed or measures implemented to protect the health and safety of the person or staff. Some checks and tests of the fire alarm and equipment were not undertaken and new staff had not participated in a fire drill in the new premises. Accidents and incidents were recorded by staff but not analysed by senior staff or managers to assess whether measures implemented were effective or needed amending. The persons health care needs were not appropriately assessed with detailed support plans around this in place.

Staff showed that they understood the principles of the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DoLS), but the provider and senior staff had not ensured that capacity assessments had been completed or a DoLS authorisation reviewed and updated.

A detailed care plan to provide staff with a step by step guide to the support the person required to meet their needs had not been developed, and staff were not recording changes that they became aware of to inform the plan of care.

A complaints procedure was not displayed and information including the complaints procedure was not in suitable formats for the person supported to understand and make use of. Staff were working to out of date policies and procedures. In the absence of formal staff meetings and management support staff were holding their own informal meetings to seek support for each other around the operation of the service and the delivery of care to the person. A system had not been established yet for the assessment and monitoring of service quality through a series of audits.

There were enough staff to support the person but they lacked all the competencies they needed to support the person safely. Seventy five percent of staff support was provided by agency staff block booking by the provider assured that a continuity of staff support was provided to the person. Agency and permanent care staff were provided with induction to their role but this was not sufficient to meet all the person’s needs.

The person was provided with space to spend time on their own. They had been supported to personalise their bedroom with small possessions and photographs and supported to maintain contact with their family. There was a lack of structure to the person’s week but staff provided them with some opportunities to go out and to attend activities; they were guided by the person about when this happened. The service was clean and well maintained.

In the absence of a registered manager interim arrangements for the oversight of this service were inadequate with inconsistent and infrequent support provided by a senior manager not based at the service. No audits to assess and monitor the quality of the service had been established.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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.

Staff had received the training and support they needed to care for people safely and effectively.

People that used the service had been provided with information about how to make a complaint. There were a range of opportunities each week to talk about their care and any concerns they had with staff. Staff and the manager knew what they needed to do to keep people safe from abuse and how to report any concerns appropriately.

People were treated with respect and dignity. They were supported to make decisions about their daily lives and things that were important to them. People chose when to get up and go to bed, what to do and what to eat and staff respected their choices. People chose how to spend their time and were provided with activities at home and in the community. We saw that staff had a good understanding of people's needs and their individual methods of communication and that people were relaxed with staff. There were enough staff on duty to support people safely.

People were encouraged to be as independent as they could by helping with tasks such as cleaning their rooms and preparing meals in line with their individual skills and abilities.

People's rooms were personalised and they told us or indicated by thier preferred methods of communication that they liked the rooms and had chosen the colour schemes.

The provider made regular checks of the service to make sure that people were getting the support they needed and the service was safe. These included asking the people who lived there for their views.