Archived: Sara Lodge

Sara Lodge is registered to provide residential care for up to six people with a learning disability, autistic spectrum disorder or a mental health condition. At the time of the inspection there were two people receiving support as part of the residential care home. The provider also operated a supported living service from the same address. The same staff team and policies covered both services. As the supported living service was inspected within the same month, we have utilised information from both inspections for each report. You can read the report related to the supported living service by selecting the 'all reports' link for Dillan Care Pathway on our website at www.cqc.org.uk .

The service had a registered manager who has been registered with the Care Quality Commission. 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 was a joyful and lively atmosphere at the home on the day of the inspection. We saw people were treated with dignity and respect by staff and staff told us how important it was to gain people’s consent before offering any care. Staff were able to demonstrate their understanding of the needs and preferences of the people they cared for, and we could see that people were assisted to be as independent as possible. The two people at the home were facilitated to attend a wide range of activities in the community, and we saw that the staff carried out activities with people at the service.

We checked medicines administration charts and found that clear and accurate records were being kept of medicines administered by staff. Care plans were personalised and detailed life histories, individual needs and likes and dislikes were recorded. Risk assessments were up to date and detailed.

There were safeguarding policies and procedures in place, and staff were able to tell us the different types of abuse and the action they would take if they had any concerns.

Staff told us they were supported well and we saw evidence of regular staff supervision and key training had been undertaken.

Staff recruitment processes included checks to confirm people were eligible to work in the UK, Disclosure and Barring Service (DBS) security checks and references. We noted that not all references had been verified prior to September 2015, but the provider had improved their processes and paperwork so recruitment processes were now more rigorous.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. The registered manager had made referrals to the local authority with regards to deprivation of liberty safeguards (DoLS) for both of the people living at the service. One had run out in March 2016, but the provider could show us following the inspection they had applied to extend the DoLS for this person.

The service had good systems and process in place to assess, monitor and improve the quality and safety of service provided. There was evidence of regular monitoring checks of the quality and safety of the service.

The service was located in two adjoining terraced houses and there was access to a back garden. The building was not fully wheelchair accessible throughout as there were stairs to the first floor bedrooms, but there were wheelchair accessible downstairs bedrooms with ensuite showers.

At this inspection, we found that care records had been updated and reorganised. Staff we spoke with told us "these care plans are now easy to follow and we use them regularly." Records showed that people received the required care as explained within their care plans.

Areas that were poorly maintained with fixtures and furniture in poor repair, had been rectified. The wobbly dining table was replaced with a new table, light fittings that previously flickered or did not work had been replaced and were in working order and were we saw broken plaster at the last visit, this had been repaired. The temperature within all areas of the home was maintained at an appropriate temperature and people we saw in the home appeared comfortable.

At this inspection, we found the provider had continued to recruit care workers. The number of staff on shift each day was increased from six to seven, to better support the two people using Sara Lodge who had one to one care needs. A key working system had been implemented. Established care staff were clear about the difference between people who had supported living needs and the two service users requiring residential care living at the location.

Overall, we found the service had taken steps to employ sufficient numbers of staff to meet people's individual needs.

The provider had made some improvements since our inspection of 7 March 2013 in relation to staff recruitment and training and records relating to these. They had introduced systems to monitor the quality of service provided although these needed further development.

We found that there were still some issues with the delivery of care. For example, care needs, such as weekly physiotherapy and initiating routine contact with family members were not happening. People had complex needs but one to one care and key working, specified in their support plans, was not provided. Records about people's care were not up to date, following review of changing needs and so were incomplete.

We also identified some new concerns, in relation to the environment for example. A table in one of the lounges was not safe, some lighting was poor and some areas of the home were poorly maintained.

Staff received some training but the files did not show appropriate levels of supervision and there were no appraisal meetings. We found that appropriate checks prior to employment had not taken place, which could put people at the service at risk of being cared for by people who were not of good character. One of two care plans was not up to date and some aspects of planned care were not recorded as being delivered. We observed that people did not receive the levels of supervision specified in their care plans. Monitoring of the quality of the service was ineffective and did not address areas needed to protect people from avoidable risks. Records were incomplete or missing which left people using the service at risk of receiving inappropriate or unsafe care.