The Ark Care Lodge Limited

The Ark Care Lodge is a residential care home which was providing personal care to 15 adults with learning disabilities at the time of inspection. The service can support up to 18 people in two adapted buildings.

The service did not always provide care and support in line with the principles and values that underpin Registering the Right Support and other best practice guidance. These values ensure that people who use services 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. People using the service did not always receive planned and co-ordinated person-centred support that was appropriate and inclusive for them.

The service is laid out over two domestic properties with a shared garden but no internal access between them. The buildings each accommodated nine people which is larger than current best practice guidelines. However the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area. There were 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

Records relating to staff recruitment, discipline and training were disorganised. They did not clearly show safe recruitment practices had been followed. It was not clear what training staff had completed. Staff were happy working for the service and felt supported by the registered manager and colleagues.

There were limited systems in place to monitor and improve the quality of the service. The registered manager had not identified the issues we found during inspection.

Checks to ensure the environment was safe were not always completed. Equipment and processes in place in relation to fire safety were not up to date.

Care records contained information which covered people's individualised care and support needs. However, risk assessments and care plans didn't always contain up to date, clear information about people's current risks.

People and their relatives were involved in the planning and delivery of their care, however, the registered manager did not seek opportunities to obtain feedback to monitor and improve the service.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; lack of choice and control and limited independence. People did not always have choice in the type of food they ate. Menus were developed by staff with limited input from people who lived at the service. Activities were limited and people were not supported to identify and pursue goals, hobbies or dreams.

People's care and support needs were met by staff who knew them well and enjoyed working with them. Staff at the service worked with health and social care professionals to ensure people's needs were met.

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.

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 22 June 2017).

Why we inspected

This was a planned inspection based on the previous rating

Enforcement

We have identified breaches in relation to safe care, staffing and governance.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Ark Care Lodge provides residential care for up to 18 people with a learning disability and/or autistic spectrum disorder and who may present behaviours that challenge services. People lived in two private dwellings adjacent to each other in a residential area. At the time of our inspection there were 18 people using the service.

At our last inspection on 9 February 2016 the service was rated as requires improvement. We found two breaches of regulations in relation to the safe staff recruitment process and systems to effectively monitor the quality of service provided and the service had also no registered manager. We asked the provider to send us an action plan setting out how they would be compliant with the regulations. However, no action plan was sent to us and no registered manager application was received.

A registered manager was not in post. The provider had appointed managers. The provider told us the managers were in the process of applying to the Care Quality Commission to be the next 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.

At this inspection we found the provider had made improvements. They along with the managers collectively provided leadership and worked with professionals to ensure people were safe and their needs were met. Improvements were found to the provider’s governance systems in place monitor the quality of service. Some audits had been completed. Further action was needed to ensure that the audits were robust and drove improvements to the quality of care people received.

We found improvements had been made to the staff recruitment process. Staff had undergone a robust recruitment process and relevant checks had been carried out before they commenced work. Staff received appropriate induction and training for their role and understood their responsibility to protect people from avoidable harm and provide safe care to people. Staff were supported through supervisions and appraisal.

The provider had taken action to improve the premises. People lived in a clean and well maintained service. Regular checks were carried out and actions taken to maintain a safe environment.

Risks were managed so that people were protected from avoidable harm whilst promoting their choices and independence. Sufficient numbers of staff were on duty to meet people’s needs both at home and to support people to access the wider community.

People were supported by trained staff in all aspects related to their medicines. People had enough to eat and drink and were involved in meal preparations. Staff supported people to access relevant health care support and services to meet their health needs. People’s rights were protected and respected. Advocacy support was made available to people. Staff understood the importance of seeking people's consent prior to providing care and support.

People's care needs were met and their lifestyle choices respected. People maintained contact with family and friends and took part in social events and activities that were of interest to them.

People’s privacy and dignity was respected. Staff helped to maintain and promote people’s independence. Staff used the knowledge gained from supporting people to continually review and update people’s care plans so that they were able to respond to people’s changing needs.

People and their relatives were involved or had opportunities to be involved in the development of the service. A complaint process was in place and staff knew how to respond to complaints.

The provider had appointed two managers. Collectively they provided leadership and worked with professionals to ensure people were safe and their needs were met. The provider’s governance systems were in place monitor the quality of service. Some audits had been completed. Further action was needed ensure that the audits were robust and drove improvements to the quality of care people received.

The Ark Care Lodge is registered to provide residential care and support for up to 18 people who have an autistic spectrum disorder or a learning disability and who may present behaviours that challenge. People live in two houses adjacent to each other with no internal access that blend in with other private dwellings in a residential area. The accommodation has two lounges with dining rooms. The bedrooms are over two floors and the upper floor is accessible using the stairs. Most bedrooms have an ensuite shower facility and are close to a bathroom. At the time of our inspection there were 18 people using the service.

The service has a manager who was registered with Care Quality Commission (CQC). A registered manager is a person who has registered with the 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. However, they no longer work for the service and have not yet cancelled their registration. We spoke with the provider representative about this and advised us that the registered manager has been informed to cancel their registration.

The provider had appointed two managers that had been in post for two months at the time of our inspection. The provider told us that they intend to have two managers to manage the service. The provider advised us of their intention to submit an application to the Care Quality Commission to become registered. We will monitor this situation to ensure that a registered manager is in post to ensure that the service is managed well.

People told us they felt safe at the service and with the staff that looked after them. Staff understood the safeguarding procedure (protecting people from abuse) and knew how to keep people safe.

People’s care needs were assessed including risks to their health and safety. Care plans developed from the risk assessments lacked guidance and information for staff as to how to support the person safely. Despite this staff were aware of people’s needs and knew how best to support them. Further action was needed to ensure care plans and risk assessments were reviewed regularly to ensure people received the safe and appropriate care and support. The provider assured us they would take action and ensure people’s needs and records were reviewed.

Staff were recruited in accordance with the provider’s recruitment procedures and further action was needed to ensure records were kept of the pre-employment checks carried out. The service had sufficient staff to meet people’s needs and support people to live independently and access community amenities.

Staff received an induction and training for their role and responsibilities. Further action to the ongoing support, training and records would help ensure staff’s knowledge; skills and practice were kept up to date.

People received their medicines at the right time from trained staff. People had access to health support and referrals were made to relevant health care professionals where there were concerns about people’s health.

People told us that staff sought consent before they were helped and that staff always respected their choices and decisions. Staff were aware of their responsibilities to ensure people’s rights were promoted and new care plan format would help ensure decisions made were recorded.

People told us staff were caring and had developed positive relationships with them. People’s privacy and dignity was maintained, their choice of lifestyle was respected and their independence was promoted.

People spent time doing things that were of interest to them such as activities, accessing community’s amenities and doing household chores to promote their independence. Records showed people went out, maintained contact with family and friends and developed new interests and hobbies.

People knew how to make a complaint and were confident that their issue would be addressed. The provider assured us that they would review and update the complaint procedure and ensure a complaint log was kept.

The provider’s quality governance and assurance systems were fragmented. The provider’s policies and procedures were not up to date or reflective of the care and support provided. There were limited audits carried out and those too were ineffective. There was limited opportunity for people who used the service and staff to make comment about the quality of service provided and contribute to the development of the service. There was no evidence to demonstrate that the provider reviewed, identified shortfalls and took steps to make improvements.

We found two 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 this report.

We observed that the people who used the service got on well together. They were caring and supportive of each other and helped each other with tasks. One person told us, 'We are a big family here.' Staff told us there were strong bonds between the people who used the service, some of whom had lived at the home for many years.

People said the food was good at Ark Care Lodge and they had plenty of choice. One person told us, 'The food is delicious. I like it best when we have pasta.' Another commented, 'We have lovely meals here.'

People told us they liked how the home looked and thought it was clean and tidy. One person said, 'I've got a nice room which is all mine and I love it.'

People got on well with the staff. One person said, 'I like all the staff here.' Another person told us, 'The staff are very kind. They never shout and are ever so friendly.' The staff team was established, knew the people who used the service well, and were able to provide continuity of care.

This service does not currently have a Registered Manager. CQC are working with the Provider to ensure one is put in place.

People were protected against the risks associated with medicines because there were appropriate arrangements in place to manage medicines. There were enough qualified, skilled and experienced staff to meet people's needs. People who use the service, their representatives and staff were asked for their views about their care and treatment and they were acted on.

The manager of Ark Lodge told us that she had not yet registered as the manager with us, however she said that she would be registering within the next three months.