We carried out a review of the data available to us about Keevan Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Keevan Lodge, you can give feedback on this service.
Keevan Lodge is a residential care home providing personal care to people with learning disabilities and mental health conditions. The care home accommodates three people in a terraced house and was fully occupied at the time of the inspection.
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.
The service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, people were given choices and their independence and participation within the local community encouraged.
Right Support
People were supported to maintain their independence and lead full lives. Staff understood how to effectively support people as individuals. The service supported people to have the maximum possible choice, control and independence be independent and they had control over their own lives. People were encouraged and supported to attend routine healthcare appointments to ensure their wellbeing. The service worked in collaboration with people to help plan and review their care.
Right Care
People were supported by staff who understood their individual needs. We observed kind and caring interactions between people and staff. People were supported by staff who were well trained and had also received training in working with people living with autism and learning disabilities. Staff understood what was important to people and supported them to take part in activities that were meaningful to them.
Right culture
The service was well run and staff were passionate about working with people. The values of the service were reflected in the care people receive. The service ensure staff understood best practices around making sure people were treated as individuals. People’s opinions were important and there were numerous systems of gaining people’s feedback. Auditing systems and people’s feedback ensured there was oversight of the care being provided. Where any learning was identified this was used to improve the quality of care.
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 requires improvement (published 19 February 2021) and there were breaches of regulation around the safe management of medicines and management oversight of the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations (regulations 12 and 17).
Why we inspected
We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.
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.
Keevan Lodge is a residential care home providing personal care to people with learning disabilities and mental health conditions. The care home accommodates three people in a terraced house and was fully occupied at the time of the inspection.
People’s experience of using this service and what we found
Improvements had been made to how medicines were managed. People received their medicines safely and as prescribed.
The provider had also made improvements to how they managed infection prevention and control and the risks associated with 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 and update
The last rating for this service was requires improvement (published 19 February 2021) and there were breaches of regulation around the safe management of medicines, infection prevention and control and good governance.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of one of the regulations (regulation 12). The second regulation in breach will be assessed at a future inspection.
Why we inspected
We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.
CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
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.
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.
People’s experience of using this service and what we found
We identified continued concerns with the safe management of medicines at the service and were not assured that medicines were administered to people safely and as prescribed. Staff had not been assessed as competent to administer medicines.
There were gaps in the provider’s infection prevention and control processes at the service which placed people and staff at risk of harm. The provider had not fully assessed the risks associated with the COVID-19 pandemic.
During this inspection we found that the management team did not have adequate oversight at the service which meant that care was not being delivered in line with the current government guidelines and legislation.
There were enough staff on duty to keep people safe, however we found that some staff worked at the service infrequently which meant that people did not always receive care from a consistent staff team. Staff were safely recruited.
Risks associated with people’s care needs were assessed and guidance was in place for staff to keep people safe. We have made a recommendation to the provider about staff training.
Staff understood their role in safeguarding people from harm from others. There were appropriate accidents and incidents procedures in place.
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 requires improvement (published 13 December 2019) and there was one breach of regulation around the safe management of medicines.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
We carried out an unannounced comprehensive inspection of this service on 11 November 2019. A breach of legal requirements was found. 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.
We undertook this focused inspection to check they 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 which contain those requirements.
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 has remained requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Keevan Lodge on our website at www.cqc.org.uk.
Enforcement
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 to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to medicines management, infection control and good governance at this inspection. The registered provider was served with a warning notice for breach of Regulation 12 (Safe Care and Treatment).
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Keevan Lodge is a residential care home providing personal and nursing care to people with learning disabilities and mental health conditions. The care home accommodates three people in a terraced house.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service 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 receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
Medicines were not always managed safely. Records did not match stocks of medicines seen on inspection.
The quality checks on the service were not consistently identifying concerns and driving improvements.
Staffing levels were satisfactory to provide good levels of care. There was a system of recruitment in place, however, there were some gaps in referencing and obtaining employment histories.
Staff received an appropriate range of induction and training to undertake their role. People’s health needs were supported, and staff alerted and involved relevant health professionals when necessary.
People were provided with a varied menu that met their dietary needs and preferences.
Staff were caring and knew people’s care needs well.
Care plans and risk assessments were detailed and provided staff with information about people's individual support needs and guided staff in how they should deliver support safely.
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 applied 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.
We received positive feedback about the management team, the culture and the quality of care provided.
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 6 March 2017).
Why we inspected
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
We have identified a breach of regulation in relation to medicines management 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 for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Keevan Lodge is a residential care home providing personal care and support for three people with learning disabilities and mental health issues.
We observed positive interactions between people and staff which indicated to us that people felt safe and confident with the staff that supported them. Staff demonstrated a good level of understanding of safeguarding and were able to tell us of the steps they would take if abuse was suspected.
The provider ensured that people were kept safe and free from harm by ensuring that people’s health and care needs were assessed in detail to identify and mitigate any potential risks.
Safe recruitment practices were observed to ensure that only staff suitable to work with vulnerable were employed to do so.
Safe medicine management systems were in place and adhered to and appropriate staffing levels had been determined according to people’s needs and requirements.
Care staff had received an induction when they first started work followed by appropriate training in order to be able to effectively carry out their role. Records confirmed that staff were also regularly supported through supervision and annual appraisals.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The provider had policies and systems in place to support this practice.
People were not required to set prescribed menus, but were able to choose what they wanted to eat on the day depending on what they fancied at that time. Shopping lists were devised with each individual person based on their likes and dislikes and people were able to communicate the level of involvement they wished to have when preparing their own meal and where support was required.
People were supported with all aspects of their health care needs which included making appropriate referrals and accessing a variety of healthcare professionals as well as being supported to attend healthcare appointments where required.
Staff and senior managers knew the people that they supported very well and were very clear about the level of support each person required but also ensuring that each person maintained their own independence as far as practicably possible.
All staff had established caring and responsive relationships with people and knew their likes and dislikes, their needs and requirements and knew each person’s mood and behaviour changes and were observed to be responsive and respectful ensuring that the person was supported appropriately.
Records confirmed that people and relatives had been involved in the planning of care. Each care plan we looked at was detailed, person centred and gave in-depth information about the person and their care and support needs which had been set according to the person’s choices and wishes.
People were able to attend and participate in a variety of activities of their choice as and when they wished. People’s cultural and religious background and needs had also been considered and where appropriate people were supported to observe and respect those needs.
The provider ensured that all complaints and concerns raised were dealt with according to their complaints policy. Relatives confirmed they knew who to speak with if they had any concerns or issues to raise.
Relatives and staff confirmed that they knew the management structure within the home and knew who to speak with. They confirmed that the management was approachable and staff also confirmed that they felt appropriately supporting in their role.
We saw a variety of records confirming that the management regularly monitored and checked the quality of care that was delivered and were issues or concerns were highlighted these were addressed so that subsequent learning could take place and improvements made to the delivery of service.
Further information is in the detailed findings below.
We undertook an unannounced inspection on 25 November 2014 of Keevan Lodge. This care home provides support to three people with learning disabilities. People at the home were unable to verbally express their views At the time of our inspection three people were using the service.
At our last inspection on 8 October 2013 the service met the regulations inspected.
The service had two registered managers in post at the time of our 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. One registered manager at the home was responsible for the operational side of the service and the other registered manager was responsible for the daily running of the service.
On the day of the inspection there was a calm and relaxed atmosphere in the home and we saw staff interacted with people in a friendly and respectful manner. We saw that people who used the service appeared comfortable around staff and with the registered managers.
We saw staff communicate with them in other ways such as using specific body language, gestures, facial expressions and key words.
There was a safe environment for people who used the service and staff. The majority of staff had received training in how to recognise and report abuse. Staff we spoke with were knowledgeable in recognising signs of abuse and the associated reporting procedures. Medicines were securely stored and administered.
We found the managers were aware of the recent Supreme Court judgement in respect of Deprivation of Liberty Safeguards (DoLS) and confirmed that currently nobody at the home needed applications made to deprive them of their liberty. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.
Assessments were undertaken to identify people’s health and support needs and any risks to people who used the service and others. Care plans were in place to reduce the risks identified.
Staff had the skills and knowledge to support people who used the service. There were enough staff available at the service and staffing levels were determined according to people’s individual needs.
The registered managers at the home were familiar with all of the people living there and staff we spoke with told us they felt supported by the management team. Regular staff meetings were held by the service and we saw evidence of this.
Staff we spoke with understood the importance of obtaining the consent of the person before any care or treatment took place. Staff confirmed they had undertaken training in the Mental Capacity Act 2005 (MCA) and were aware that the service must always act in the best interests of the person when they lacked capacity.
People who use the service told us that they felt safe with the staff who supported them. One person told us 'I'm safe here. They look after me properly.'
Staff were positive about working at the home and told us they were supported by the management through regular supervisions, staff meetings, good training opportunities and appraisals. Staff we spoke with confirmed that they had not been allowed to start working with people until all relevant employment checks had been carried out.
There was evidence that the manager spoke with people using the service to gain their views about their care as well as identifying any areas for improvements. There were regular house meetings and one to one sessions and records of these indicated that people were able to express their views about the service.
People told us that staff were kind and respected their privacy. One person commented, 'I like it here'.
We observed staff supporting people in a friendly and professional way and saw that people were being offered choice with regard to menus and activities.
Staff we interviewed were able to give us examples of how they maintained peoples' dignity, privacy, independence and how they offered choices to people on a daily basis.
We asked people who use the service what they thought about the care and treatment they receive at the service. They responded positively and said they felt supported by the staff team and that they were included in decisions about their care as far as possible.
One person commented, 'I go to the park and I go to college on a Wednesday'.
We observed that the way staff were supporting people in the home had a positive effect on their well being. Staff we interviewed had a good understanding of the needs of the people they supported.
People who use the service indicated to us that they felt safe with the staff at the home.
Staff we interviewed were aware of the different types of abuse that can happen to people in a care setting. Staff were also able to give us examples of signs they would look out for that may indicate a person may be being abused.
Staff told us that if they ever suspected abuse was taking place they would inform the manager immediately. Staff confirmed that they had undertaken training in safeguarding people from abuse.
People who use the service indicated that they were happy with the staff who support them.
One person commented, 'They are nice, they work hard'.
We observed staff being appropriately supported by the management so that they could provide for the care needs of the people who use the service.
People who use the service confirmed that the staff ask them how things are going and if they are happy with the care provided at Keevan Lodge.
We saw that the home was decorated and furnished to a good standard and peoples' rooms had been individualised to reflect their own personalities. No issues were identified in relation to the maintenance of the building during our visit.