Adrian Lodge

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

People were supported by staff who were familiar with their needs and were observed as being kind and responsive. People spoken with had some opportunity to go out and develop their independence with staff support.

Some people's needs had changed which meant they required additional support to stay safe. This was not reflected in the staff hours provided by the service. Three people had some one to one hours when staff supported them to go out or complete tasks within the service. Other people had shared support and staff had limited amount of time to spend with them.

Not all risks were appropriately assessed and monitored to ensure people were kept safe. People lived in a poorly maintained environment which made it more difficult for staff to keep clean. Facilities were poor.

Individual risks were not clearly identified and planned for. For example, staff did not keep fluid charts where people were prone to infection. Staff had not taken fully into account the recent hot weather and how this might impact on people’s general health and wellbeing.

People were not fully supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; For example staff had sought consent to keep the main fridge in the kitchen locked but had not documented the clear rationale for this or considered if this was the least restrictive option.

Medicines were safely managed but people even those who took their own medicines were required to go to the medicines room which was not a very person-centred approach. We have made a recommendation about monitoring the use of medicines prescribed to be administered when required.

People discussed their care needs with staff regularly, but daily care notes and monthly reviews did not clearly focus on people ‘s wellbeing and mental health or identify new or unmet need.

Governance and provider oversight was poor which had led to a lack of investment and quality improvement. The last CQC inspection to this service was on 4 October 2018. Although rated good safe was rated as requires improvement and we found robust actions were not taken to address our concerns. During a more recent inspection by the local authority in 2021 and a CQC review of the service in 2022 we found a continued lack of effective monitoring or action to address the issues found.

The registered manager was highly regarded by staff and people using the service and was engaging with health care professionals to get people’s needs reassessed where changes were noted in their physical and mental health exacerbated by the COVID 19 pandemic.

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 14 December 2018.)

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

This inspection was prompted by a review of the information we held about this service. A decision was made for us to inspect and examine those risks. We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this report.

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.

You can see what action we have asked the provider to take at the end of this full report. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the environment, quality monitoring and assessing risk at this inspection. 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.

Adrian Lodge is a care home. 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.

Adrian Lodge can accommodate up to ten people who have a diagnosed mental health condition. It does not provide nursing care. At the time of our inspection there were nine people living permanently at the service.

The service is situated on the edge of the town of Kings Lynn and provides accommodation on ground, first and second floor. It also had a cellar.

At the time of our inspection there was a registered manager in post. 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.

During our most recent inspection we had a number of concerns about the building in relation to its current use and the physical needs of people using the service. Some people had been using the service for many years and their physical and cognitive needs were changing which meant that the service may no longer be appropriate. For example, there was a steep flight of stairs which could not be adapted and there was no lift on the premises. Some risks posed from the environment had not been considered in the overall environmental risk assessment. This included uncovered radiators and potential ligature risks. The registered manager said no one was presenting with unstable mental health or at risk of self -harm.

We had concerns about fluctuating staffing levels at the service. At times there was only one member of staff in the building and people were not regularly monitored at night to ensure they were safe and well. We had concerns about how one member of staff would be able to adequately respond to adverse incidents within the service and keep themselves and others safe.

The registered manager said additional staffing could be provided if people’s needs changed. However, we felt within the existing staffing levels people did not get much input in terms of individualised support or encouragement to participate in the wider community which might increase their emotional resilience.

We found, overall, other factors considered, that the service was safe and individual and generic risk assessments helped to ensure the building and equipment was safely maintained and individual risks identified and controlled.

People received support from a well-established and experienced staff team which helped people feel secure.

There were robust systems in place to help ensure medicines were there for when people needed them and were administered as prescribed.

There were robust staff recruitment processes in place to help ensure only suitable staff were employed and this helped to protect people using the service who could be vulnerable by their circumstances.

Staff knew how to safeguard people from abuse and were skilful in intervening as necessary to ensure people were appropriately supported with their emotional and mental health.

Staff were well supported by the registered manager and had trust and confidence in them. There were robust systems in place to ensure all staff had access to the training they needed and had a sufficient induction into their role. Staff received regular support and time to meet up to discuss their progress and training needs.

People were supported to maintain good health and access the services they needed. They were supported with meal preparation and eating and drinking enough.

Staff understood how to support people lawfully in line with legislation relating to mental capacity. People were free to make their own decisions in the least restrictive environment as possible.

Staff were caring and spent time with people actively listening to people and helping them to reach decisions and take control over their lives. They provided the necessary emotional support and were skilful in their approach.

People were empowered by the approach used by staff. People were encouraged to be independent and participate in meeting their own needs and helping to contribute to the cleanliness of the service.

People were actively involved in their care and support and had regular consultation with staff and their key worker. A key worker is a named member of staff who is assigned to the person to oversee their care and support.

Care and support plans were drawn up with the involvement of the person. The service could evidence how much time they spent supporting the person and what with. This was regularly reviewed to help ensure the person was getting the level of support they required. We had concerns about staffing levels and the potential impact this had on people’s support needs when staffing levels were reduced.

End of life planning had not been taken in to consideration when assessing and reviewing people’s needs and staff had not had training provided by this service. At the time of our inspection there was no one receiving palliative care.

The service had an accessible complaints procedure. There were no recorded complaints and it was clear that people had regular opportunities to raise issues and these were resolved immediately.

The service had an experienced, registered manager who had very good interpersonal skills and was proactive in supporting their staff and people using the service.

The service had robust record keeping and clear auditing processes designed to identify how the service was being managed and to have a clear plan to address any shortfalls but had not taken into account staffing and some environmental factors.

Adrian Lodge provides accommodation and residential care for 10 people living with mental health issues. At the time of our inspection the home was providing support to 10 people. The home had a registered manager in post. 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 were systems in place to protect people from abuse, staff had received appropriate support and training which enabled them to identify the possibility of abuse and take appropriate actions to report and escalate concerns. Risks were assessed and managed appropriately through the use of detailed risk assessments.

There were systems in place to monitor the safety of the environment and equipment used within the home minimising risks to people. There were arrangements in place to deal with emergencies.

There were safe staff recruitment practices in place and appropriate recruitment checks were conducted before staff started work ensuring people were supported by staff that were suitable for their role. There was enough staff on duty to meet the needs of the people living at the home.

Medicines were managed, stored and administered safely by trained and competent staff.

There were processes in place to ensure new staff were trained appropriately and staff received regular training, supervision and annual appraisals. Staff gained consent for the support they offered people. The registered manager and staff were able to demonstrate their understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards legislation.

People were supported to maintain good health and had access to a range of health and social care professionals when required. People's nutritional needs and preferences were met.

Staff had a good understanding of the needs of the people and how they liked to be supported. Staff spoke with and treated people in a respectful and caring manner and interactions between people, their relatives and staff were relaxed and friendly. Staff respected people's privacy and dignity. People and their relatives told us they were made welcome in the home.

People received care and treatment in accordance with their identified needs and wishes. Care plans documented information about people's personal history, choices and preferences and preferred activities.

There was information on how to make a complaint was on display on the notice board for people living at the home. People knew how to complain and felt that when they did that their concern was taken seriously.

People and their relatives felt that the atmosphere in the home was open, friendly and welcoming and that the registered manager and staff were approachable.

There were systems and processes in place to monitor and evaluate the quality of the service provided. The management of the home's records were maintained to a good standard. The records that we inspected were clear and easily accessible for staff to use.

The service had a positive culture that promoted independence and was responsive to peoples changing needs.

Below is a summary of what we found. The summary describes what people using the service, relatives 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.

This is a summary of what we found:

Is the service caring?

Our observations showed us that people living in the service were treated with respect at all times. Staff knew the routines that people had chosen and were aware of their care and support needs. We saw staff supporting people in a caring and considerate manner.

Two people who lived in the service said that they were looked after, supported and had everything they needed at this time.

Is the service responsive?

We saw that people's individual social and physical needs were being met. People were encouraged to decide what they wanted to eat and what they wanted to do on the day of our inspection. We saw that staff allowed time for the individual to fully understand their choices and the options offered to them. Staff introduced people to us and then continued to include them in our conversations throughout the day.

Is the service safe?

Records showed us that risk assessments were completed for any activities inside and outside of the service. All assessments included an evaluation for the level of risk that was presented plus any actions to be taken to reduce or eliminate such risks. Lawful requirements under the Mental Capacity Act 2005 were recognised and staff expressed a thorough knowledge of matters relating to the Deprivation of Liberty Safeguards (DoLs).

People who lived in the service told us that they felt safe and if they had any concerns they spoke with staff. One person told us, 'I talk to (name of key worker) and they help me.'

Is the service effective?

We saw positive interaction between members of staff and people who lived in the service. People were relaxed and looked happy, particularly when staff were talking and supporting them in any way.

The bedrooms we saw at this inspection reflected the personality of the person. We were told by one person that they liked the room because it suited them and they then explained how comfortable they were.

Is the service well led?

Staff explained that they undertook regular training and we saw a list of dates that showed us that training was updated regularly. People were therefore supported by a staff team who knew how to provide support in a safe and appropriate way.

Quality assurance systems were in place and regular quality audits were completed for all areas of the service. We saw records that clearly documented the observations that had been made when any improvements were needed. The dates of completion were also recorded when maintenance or alterations had been completed.

We saw that people had been given accurate information about the fees they would have to pay. Records showed that people had been correctly charged for the facilities and services they had received.

People said 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.

We saw that people received medication in a safe and reliable way.

Documents and records were accurate and supported staff to provide people with the care they needed.

We examined documentation which demonstrated to us that people received appropriate care and support that met their needs, and that they also had full access to external healthcare services.

People lived in a clean and appropriately maintained environment. Policies and procedures were seen to be in place to reduce the risk and spread of infection.

People were cared for, and supported by, suitably qualified, skilled and experienced staff. Appropriate checks were undertaken before staff members began working with vulnerable people.

There was an effective complaints system in place, and when people did complain about the services provided to them they were responded to appropriately.