Park Lodge Care Solutions

Park Lodge Care Solutions is a residential care home providing accommodation and personal care for people with learning disabilities, autistic spectrum conditions and a variety of associated health needs. At the time of the inspection there were nine people living at the service. The service can support up to 10 people.

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

People received person-centred support from staff who knew them well. People’s independence was promoted, we observed people helping with day to day chores such as cleaning. One person told us, "they help me keep my room tidy" and "I cook, I am good at it, I like to cook Chinese food.”

People were supported by enough staff, one staff member told us, “I love helping people, I like that every day is different but everything we do is for the good of the residents. [Registered manager] is getting in lots of fun things for the residents to do, we try to make sure they are happy all the time, there is nothing I don’t like.”

People received safe care; their medicines were administered by staff who were trained and competent. Staff received safeguarding training and demonstrated an understanding of appropriate reporting. Lessons were learned when things went wrong, people and staff were involved and kept informed of any changes made in the service as a response.

People’s risks were assessed and minimised, allowing them to optimise their lives. The registered manager told us, “We talk to people, find out their hopes and wishes and do everything we can to minimise the risks so they can live their full lives.” People were supported to maintain important relationships. The service sought professional input to promote positive outcomes for people. Holistic approaches were used, one person was due to start Tai Chi to reduce anxiety and improve their mood.

People were empowered to make decisions and were asked for feedback on the service. One person told us, "I think I could make changes, but I don’t want to make any changes.” The registered manager described how they ensured they were visible in the service and told us, “I go around the house all the time, I make sure residents know I am there to talk to.”

Systems and processes were in place and the registered manager had a good oversight of the service, where audits highlighted areas for improvement, action plans had been created. The registered manager understood their obligations to report and respond to incidents.

People were supported to maintain links and access the community, for example, attend day centres and go to cafes.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting maximises people’s choice, control and independence. People had communication methods to maximise their choices. People personalised their bedrooms and were asked their opinions on the environment.

Right care:

• Care is person-centred and promotes people’s dignity, privacy and human rights. Planned care was person-centred and holistic to meet people’s needs.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. People were supported to give their views and were listened to.

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 5 April 2018).

Why we inspected

This was a planned inspection based on previous ratings to review the key questions of safe and well-led only.

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.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Park Lodge Care Solutions 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.

Park Lodge provides care and accommodation for up to 10 people with learning disabilities. On the day of our visit eight people lived in the service. In relation to Registering the Right Support we found this service was doing all the right things, ensuring choice and maximum control. Registering the Right Support (RRS) sets out CQC’s policy registration, variations to registration and inspecting services supporting people with a learning disability and/or autism.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a new registered manager in post since the last inspection. 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.

At the last inspection on the 28 July 2016, the service was rated Requires Improvement overall and Requires Improvement in Safe, Effective and Well-Led.

At this inspection we found the service Good overall.

Why the service is rated good:

We met and spoke with all the people living in the service during our visit. People were not all able to fully verbalise their views and used other methods of communication, for example pictures. Due to people’s needs we spent time observing people with the staff supporting them.

The service was now safe. At our inspection in July 2016 there was a breach of Regulation. The provider had not ensured care and treatment had been delivered in a safe way because medicines had not always been managed and administered safely. This is breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The report for July 2016 stated; “The providers processes had not ensured that people always received their medicines as prescribed and intended.” At this inspection we found people received their medicines and they were managed safely. Medicines were stored, given to people as prescribed and disposed of safely. Staff received medicines training and understood the importance of safe administration and management of medicines.

The service was now effective. At our inspection in July 2016 it recorded that the service was not consistently effective. The report for July 2016 stated; “The provider had not ensured all staff had completed the training the provider considered to be mandatory.” At this inspection we found that all staff had completed suitable training and had the right skills and knowledge to meet people’s needs. New staff completed an induction programme when they started work and staff competency was assessed. Staff also completed the Care Certificate (A nationally recognised training course for staff new to care) if they did not have any formal care qualifications. Staff confirmed this training covered the Equality and Diversity policy of the company.

The service was now well-led. At our inspection in July 2016 it recorded that the service was not consistently well led. The report for July 2016 stated; “At this inspection we found that the provider had followed their action plan and that steps had been taken to ensure the breach was met, (This was for a breach of Regulation 17 in the inspection completed December 2014), however some of the improvements made needed to be embedded into day to day practice and sustained in order to ensure that the service is able to continuously improve.” It went onto say; “At this inspection we found the registered manager had not consistently completed the monthly audits in line with the provider's policies and procedures.” At this inspection we found those improvements had been embedded into the service. We also found the new registered manager and provider had monitoring systems in place which enabled them to identify good practices and areas of improvement.

People were kept safe as staff had completed safeguarding training and staff had a good knowledge of what constituted abuse and how to report any concerns. Staff knew what action to take to protect people against harm and were confident any incidents or allegations would be fully investigated.

People had support from sufficient levels of staff to meet their needs People were protected by safe recruitment procedures to help ensure staff were suitable to work with vulnerable people.

The company’s website states; “We are committed to providing safe, effective and responsive care. This means care founded upon principles of respect, privacy, dignity and an on-going commitment to providing the best outcomes.”

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. People’s safety was paramount. Information on all significant events and incidences had been document and analysed. Evaluation of any incidents had been used to help make improvements and keep people safe. Improvements helped to ensure positive progress was made in the delivery of care and support provided by the staff. Feedback from relatives, professionals and staff had been sought to assess the quality of the service provided.

People lived in a service which had been designed and adapted to meet their needs and was found to be clean and hygienic. The environment had been assessed to ensure it was safe and meet people’s needs. The service was monitored by the registered manager and provider to help ensure its ongoing quality and safety. The provider’s governance framework, helped monitor the management and leadership of the service, as well as the ongoing quality and safety of the care people were receiving.

People were supported to live full and active lives and were able to access a wide range of activities that reflected their personal interests and hobbies. People were offered a choice of meals, snacks and drinks while maintaining a healthy balanced diet. People had input as much as they were able to in preparing some meals and drinks. People who required assistance were supported in a respectful and dignified way.

People’s care and support was based on legislation and best practice guidelines, helping to ensure the best outcomes for people. People’s legal rights were upheld and consent to care was sought.

People were supported to maintain good health through regular access to external health and social care professionals, such as speech and language therapists. This helped to ensure people’s health and wellbeing was monitored and appropriate actions taken.

People’s care records were detailed and personalised to meet individual needs. Staff showed they understood people’s needs and responded when needed. People were not all able to be fully involved with their support plans, therefore family members or advocates supported staff to complete and review their support plans. People’s preferences were sought and respected.

People’s emotional and behavioural needs were recognised and met. People were treated with kindness and compassion by the staff who valued them. People were engaged in different activities during our visit and enjoyed the company of the staff. People were busy and there was a happy and relaxed atmosphere within the service.

People’s equality and diversity was respected and people were supported in the way they wanted to be. Care plans were person centred and held full details on how people’s needs were to be met, taking into account people preferences and wishes. Information included people’s previous history, including any cultural, religious and spiritual needs.

People who had complex communication needs had these individually assessed and met. Staff informed us how they changed their approach to help ensure each person received individualised personal support.

People’s end of life wishes were not currently documented, however the registered manager was in discussions with family to complete this. This would help staff understand people and families wishes if required.

People lived in a service where the provider’s values and vision were embedded into the service, staff and culture. Staff spoke positively about the registered manager and the company. The registered manager was committed and passionate about the service, including the people and staff, and the company they worked for. Staff also spoke passionately about the people they cared for and the respect they held for people.

People benefited from a registered manager who worked with external agencies in an open and transparent way and there were positive relationships fostered. The registered manager kept their ongoing practice and learning up to date to help develop the team and drive improvement. They notified the Commission of significant events which had occurred in line with their legal obligations. For example, regarding safeguarding concerns, and injuries.

The provider had an ethos of honesty and transparency. This reflected the requirements of the duty of candour. The duty of candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

This comprehensive inspection took place on the 28 July and 4 August 2016 2016. Some of the people who use the service have autism and can become distressed if their daily routine is not followed. Therefore we gave the registered manager one days’ notice of the inspection so they could ensure they had sufficient numbers of staff on duty to facilitate the inspection without disrupting the daily routines of the people who lived at the service.

The accommodation was arranged over three floors. The upper floors were accessed by a flight of stairs and there was level access to the rear of the property and gardens. The service had the use of a vehicle which was used to transport people to activities.

The service had a registered manager. 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.

The service was previously inspected on 9 December 2014 and we found two breaches of the Health and Social Care Act 2008. These were in relation to people’s care plans and risk assessments not being up to date, staff had not received supervision or an annual appraisal as often as the providers policy stated, residents and relatives meeting minutes had not been typed up and some shortfalls identified as part of the providers own quality assurance processes had not been addressed such as the laundry room was in need of refurbishment. The provider submitted an action plan to address these shortfalls and we reviewed the effectiveness of this plan as part of our inspection. At this inspection we found that the provider had followed their action plan and the breaches were now met. However some areas of practice still needed to be embedded and sustained. We also identified concerns in relation to the administration and management of medicines.

The management of medicines was not always safe. The provider had not ensured that people’s medicines administration records (MAR) were accurately completed, gaps on the MAR were unaccounted for, the guidelines in place for when as and when needed medicines should be administered where not always in place and one person had not received their medicines as prescribed and intended. This is an area of practice that requires improvement.

Improvements had been made in relation to quality assurance. Action had been taken to address the shortfalls identified as part of the providers own quality assurances processes. The laundry room had been refurbished and shortfalls in relation to cleanliness had been addressed. The provider had systems in place to ensure that audits were completed to check that staff were following the providers policies and procedures. However the registered manager had not consistently completed these audits or recorded the date that shortfalls identified as needing to be rectified had been actioned. This is an area of practice that needs to be fully embedded and sustained.

Improvements had been made in relation to the recording of relatives, residents and staff meetings which were held on a regular basis. A record had been maintained of who had attended the meetings. However the minutes of these meetings were not all available to view in order to demonstrate the actions taken in response to feedback. This is an area of practice that needs to be fully embedded and sustained.

Improvements had been made in relation to peoples care records. Care plans were in place to direct staff on how people needed and wanted to be supported. These had been reviewed and updated on a regular basis.

Improvements had been made in relation to the supervision of staff. Plans were in place for each staff member to receive supervision with their line manager in line with the provider’s policies and procedures and each member of staff had an annual performance appraisal scheduled.

Improvements had been made in relation to risk assessments. Risks to people had been assessed and steps had been taken to reduce any risks identified and these had been kept under review and updated on a regular basis.

The provider ensured there was always enough staff on duty with the right skills and experience to meet people’s needs. Staff allocated to work with people with specialist needs such as epilepsy, autism and behaviour that challenged others had been trained to meet these needs. The provider had ensured staff had completed an induction to the service before they were allocated to work unsupervised. However some staff who had been employed for more than a year had not completed some of the training that the provider considered to be mandatory. Whilst we did not assess this had resulted in any harm occurring, this is an area of practice we identified as needing improvement in order to ensure

People enjoyed the food on offer and were involved in the preparation of meals. They had access to a range of activities they enjoyed such as attending day centres and going on day trips. People were supported to travel to social clubs and to go into the local community to go shopping or go to the cinema. One person told us “I keep busy, I do something every day. I can choose what I do but I join in with most things”.

People were supported by kind and caring staff who treated them with dignity and respect. Most people told us they were happy with the care and support they received. People referred to staff as being “Very kind”. And “Lovely”. One person told us “If I feel upset about something I go to staff straight away and they help me”.

We observed that staff had the skills they needed to interact and communicate effectively with people. People told us they supported to maintain relationships with people that mattered to them and their visitors were welcomed into the service.

The atmosphere at the service was relaxed and informal. People were at ease with staff and each other and jokes were shared in the many conversations we heard throughout the inspection. Staff responded to people when they approached them and we heard staff checking people’s welfare throughout the day and asking them how they were. People’s rooms were personalised to reflect their personalities.

There were systems in place to respond to complaints. People told us they knew how to make a complaint. One person told us “I would speak to the manager”. Other people told us they would “Tell the staff” or “Tell my key worker”.

Staff knew people well. They had access to guidance on how people needed and preferred to be supported and told us they kept up to date with changes to people’s care needs through staff handovers and verbal updates. Staff felt supported by management and each other.

Staff were aware of and worked within the principles of the Mental Capacity Act. People were routinely asked for their consent before staff delivered care. One person told us “They (the staff) never force you to do anything.”

There was one area where the provider was not meeting the requirements of the law. You can see what action we told the provider to take at the back of the full version of the report.

Plans of care were person centred and included up to date risk assessments

We saw that the medication system was robust and found that people were supported to receive their medicines safely and as prescribed.

The recruitment and selection process in place involved the people using the service and ensured that all staff had appropriate checks before starting work and undertook the relevant training.

Systems were in place to assess and monitor the quality of the service. Feedback was sought from people involved with the service and the provider was responsive when issues were raised and lessons were learnt from incidents.

We found that the care plans had been developed in a person centred way which guided staff to ensure they were providing care that was responsive to the individual's personal preferences, needs and values.

Records showed us that staff were trained about how to keep people safe. Staff had a clear understanding of the

policies and procedures to follow if they saw or suspected that someone was at risk.

The staff we met carried out their work in a calm, friendly but professional way. One of the people who used the service told us, "the staff here are good for me. They've helped me to talk about things to make them better."

Records showed that people were supported to be a part of house meetings with staff when they chose to.

Records also showed that a manager carried out a monthly quality assurance audit. These reviews included areas such as notifications to CQC, meals, activities, care files, risk assessments, discussions with staff, training, health and safety, and the environment. We also saw other audits had been carried out for things like medication arrangements. We noted that, where these audits had identified areas for improvement, actions had been taken to increase the levels of monitoring with a view to ensuring the safety of people who used the service.