Spencers Lodge

Spencers Lodge is a residential care home providing accommodation and personal care for up to eight people who experience needs related to learning disabilities. At the time of the inspection there were seven people living in the home.

The home had been developed and designed before the principles and values that underpin Registering the Right Support (RRS) had been published. This guidance aims to ensure that people who use services can live as full a life as possible and achieve the best 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 is larger than recommended by best practice guidance and is situated on a campus style setting with four other homes and the provider’s adult skills service. However, the service had applied the principles and values of RRS and had mitigated against environmental factors that would otherwise reduce the likelihood of being able to provide truly person-centred care.

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

People and their relatives told us Spencers Lodge was a safe place to live. People said they were happy living there and staff supported them in the ways they preferred.

Systems for managing and reporting incidents had been improved and enabled actions to be taken to reduce the likelihood of similar incidents occurring in the future. People were supported by staff who understood how to keep people safe from harm or abuse.

People were supported to take positive risks to maintain their independence and social relationships. They received their medicines in a safe way. Measures were in place to minimise the risks related to the spread of infections.

There was an open and inclusive culture which enabled people to be involved in how the home was run. Governance systems enabled a continuous learning and improvement approach for the benefit of the people who lived at Spencers Lodge.

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 Spencers Lodge was requires improvement (published 22 October 2019) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out this focused inspection to check the provider 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. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

As part of this inspection we also looked at the measures in place to control and prevent the spread of infection in the home. This was part of our thematic review of infection prevention and control in care homes.

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

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.

Spencers Lodge is a residential care home registered to provide accommodation and personal care for up to eight people who experience needs related to learning disabilities. The home is on a campus style setting with four other homes and the provider’s Adult skills provision.

The service was a large home, bigger than most domestic style properties and was located on a campus style setting. It was registered for the support of up to eight people. Eight people were using the service at the time of inspection. This is larger than current best practice guidance

The service didn’t always consistently apply the principles and values of Registering the Right Support 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.

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

We found that were supported to take positive risk, however this was not always documented on how the risk was mitigated. Infection control best practice was not always followed. There were a lack of systems and processes to analyse accidents and incidents. People who used the service felt safe. Staff received safeguarding training and understood their responsibilities around this. Medicines were administered safely, and people received prescribed medicines. Relatives told us they felt their loved one was safe in the service.

We found a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12 safe care and treatment.

People’s nutritional needs were not always risk assessed and managed effectively. People were supported to access on-going health care support in the community. People were assessed prior to admission to the service. Staff had on-going and regular supervisions and appraisals. The premises were fit for purpose but would benefit from refurbishment. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, this was not always evidence to show the involvement of people during decision making. People were able to choose decoration and furnishings for personal areas of the service. People were able to set goals for themselves.

People’s dignity was not always protected. Staff and people had good relationships and had good knowledge of their support needs. People who used the service said the staff were kind. We observed positive interaction between staff and people. People told us staff had a kind and caring approach. Staff supported people and their relatives to maintain relationships and visits when there had been barriers to this. People who used the service felt they were listened to by staff and could speak to them if they wanted to give feedback.

People had care plans but were not always reflective of their current needs. People did not always feel their concerns were listen to and responded to appropriately. Information was accessible to people in the service. People were involved with activities and had education and work opportunities available to them. People allocated additional support hours on a one to one basis, did not always receive the full hours. People always had access to their care records and were involved in the development and review of these. People were supported to maintain personal interests.

Systems and process were not always effective in identifying concerns and driving improvements in the service. People who used the service were supported to be involved. Staff and people felt the registered manager was approachable. The provider did not notify us of some events which happened in the service. This was a breach of regulation. There was a positive culture in the home and the team felt supported by the registered manager.

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 (last report published on 1 November 2016). At this inspection the rating had changed to requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

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 Spencers Lodge on our website at www.cqc.org.uk.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Spencers Lodge is registered to provide accommodation and personal care for up to eight people who experience needs related to learning disabilities. It is located in the grounds of Toynton College in Toynton All Saints near Spilsby in Lincolnshire.

There was an established registered manager in post at the time of the inspection. 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 enjoyed living at Spencers Lodge and were supported to have as much control over their lives as they were able and wanted to have. They and their relatives, were involved in planning and reviewing their individual support. Staff had a very clear understanding of people's needs, wishes and aspirations. They received their support in a personalised way with a focus on helping them to maintain and develop their independence. People’s health and nutritional needs were well supported to enable them to stay healthy. They were supported to engage in meaningful activities and maintain and develop their personal interests.

People were safe living in the home. Staff were trained and supported to identify and manage any potential risks to people’s health, safety and welfare. The provider had systems in place to ensure that people were protected from the risk of abuse and staff knew how to contact other agencies to report any concerns of this nature. The provider also had clear systems in place to ensure that they only employed staff who were suitable and safe to work with people who lived in the home.

The provider and the registered manager ensured there were enough staff with the right skills to promote and maintain a persalised approach to supporting people. Staff were trained and supported to manage people’s individual needs, and to keep up to date with good practice and relevant legislation. Their training programme included courses about the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

CQC is required by law to monitor the operation of the MCA and DoLS and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. People’s rights were respected in accordance with this legislation. They were supported to make decisions for themselves wherever they were able to do so. Where restrictions to their freedom had been authorised, the conditions applied to the authorisation had been met.

The home was run in an inclusive and open way which enabled everyone to express their views. There were systems in place to enable people, their relatives and other visitors to raise concerns or complaints and have them resolved. People and their relatives also had more formal opportunities to provide their feedback about the quality of the service by way of satisfaction surveys.

Systems were in place to ensure that any shortfalls in the quality of the services provided were identified and improved in a timely manner. The systems included regular audits of the key areas of support and practice.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service and staff told us.

If you want to see the evidence supporting the summary please read the full report.

Is the service safe?

Students were protected from the risk of abuse.

Staff had received training to make sure students stayed safe and they had a good understanding of the processes for reporting any concerns.

There was a policy in place which described what safeguards needed to be observed if a student needed to have their freedom limited. This was so that any restrictions used were the least necessary and were reviewed regularly.

Is the service effective?

Students and their families were given all of the information they needed to enable them to make a choice of whether or not to use the service.

Students and their families were involved in the care assessment, planning and review processes. There was a clear transition process and good support to help students settle in to the home and get the right level of support for their needs.

Staff had received training about student's individual needs to enable them to provide effective support.

Is the service caring?

Students were relaxed and comfortable in the company of staff. Staff demonstrated their respect for student's individual needs and wishes.

A student told us, 'It's great, I am very happy here. I have lots to do like horse riding, Wii, Skype and I like board games.'

Family members told us things like, 'I can't find fault, XXX has made wonderful progress there' and 'I am confident in the staff, they are in tune with XXX's likes and dislikes. XXX has made amazing steps forward.'

Is the service responsive?

Family members told us they knew how to make a complaint if they needed to. They said that if they had any concerns they spoke with staff or the manager and the issues were resolved quickly.

Staff responded quickly to suggestions raised by students and their families in regard to the care and support provided. A family member said, 'The staff listen and respond to any suggestions we make.'

The provider had responded in the right way to the things we said needed to be improved. They also responded in the right way to updated national guidance about care practice.

Is the service well-led?

There was a system in place to regularly assess the quality of support provided for students. This included gathering the views of students and their families. The systems ensured that action plans were in place to address any issues highlighted.

Clear communication systems were in place within the home and within the wider organisation which made staff feel valued and helped them to maintain consistency with student's support.

Staff felt well supported by the manager and they were able to share their views in an open atmosphere.

Staff had consulted with students and parents about the support each person needed and wanted to have.

Students said that they received all of the health and personal care they needed. Records confirmed that assistance had been provided in a safe, reliable and responsive way.

There were safe and reliable systems for managing students' medication.

Some of the necessary security checks on staff had not been completed. This reduced the confidence people could have that only suitable and trustworthy staff were employed.

There was an effective system for dealing with complaints so that issues could be resolved quickly and fairly.