Ummah Lodge

The care service has 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.

At the time of the inspection there were a limited number of people using the service.

The service had a registered manager in place. 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 our last comprehensive inspection on 10 July 2017 we rated the service overall 'Requires Improvement', as well as in the areas of Safe, Effective, and Well-led. This was because we identified one breach of legal requirement as the provider did not ensure the proper and safe management of medicines. We also identified staff did not have appropriate understanding of the Mental Capacity Act 2005 and that the service did not have a registered manager in place to ensure the quality of the service was monitored and improvements were made as required.

At this inspection we found there were no breaches of the regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014, and we rated the service overall as Good. We found that the registered manager had made improvements in all areas of concerns we identified at the last inspection. However, at this inspection we found that parts of the premises were in disrepair, had tiles which were missing and carpets which were stained. We recommended that the registered manager needed to make improvements in these areas.

Staff understood their responsibilities regarding the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff received the training and support that they required to carry out their roles in meeting people’s individual needs and supporting their independence.

People’s medicines were managed safely. Staff liaised with healthcare and social care professionals to ensure that people’s health, medical and care needs were met by the service.

Staff were knowledgeable about people’s needs and engaged with them in a respectful, sensitive and encouraging manner. Staff had a caring approach to their work and understood the importance of treating people with dignity, protecting people's privacy and respecting their differences and human rights.

There were arrangements in place to ensure people were safe in the service. Risk assessments were completed and staff knew how to manage risks to ensure people were safe.

People's care plans were up to date and personalised. They included details about people’s needs and preferences, and guidance for staff to follow so people received the care and support they needed.

People had the opportunity to take part in a range of activities that met their interests and needs.

Staff recruitment procedures were robust ensuring that staff employed were appropriately checked and were suitable to work with people. There were enough to support and meet people's needs.

People using the service were supported and encouraged to choose their meals. Their dietary needs and preferences were accommodated by the service.

People’s relatives knew how to raise a complaint and were confident that any concerns would be taken seriously.

Various aspects of the service were monitored and improvements made through ongoing auditing processes.

Incidents and accidents were monitored, recorded and lessons learnt to make further improvements.

At our last comprehensive inspection of this service in February 2017, we identified seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the service was rated overall inadequate. The breaches related to the provider not having a registered manager in place to run the service. There were insufficient systems in place or continuous oversight to make improvements. We found a lack of sufficient risk assessments and guidance for staff. We had concern around medicine management, the staff recruitment process, insufficient training and support for staff, a lack of person centred support plans and lack of activities.

After the comprehensive inspection, the provider wrote to us to say what action they would take to meet legal requirements.

As part of this inspection, we checked if improvements had been made by the provider in order to meet the legal requirements.

The service is registered to accommodate up to ten people with learning disabilities who may also have mental health needs. People living at the service were supported by two personal assistants during the daytime, who they directly employed and were therefore outside the scope of our inspection. People were only supported by staff employed by the provider during the evening and night. There was one person using the service at the time of our inspection.

The provider did not have a registered manager in post, although at the time of writing this report, they informed us of their intention to make an application to become the registered manager and had taken the necessary steps to apply to 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.

During this inspection, we found people were not protected against the risks associated with the unsafe management and use of medicines. Staff did not receive regular competency checks to ensure they had the correct skills for administering medicines.

Records relating to the recruitment of new staff showed that relevant checks were completed before staff worked unsupervised at the service.

A safeguarding procedure flow chart was in place and staff were aware of their roles and responsibilities to report safeguarding concerns. Staff had undertaken safeguarding adults training and they were aware of the signs and symptoms of abuse. A policy and procedure about the use of restraint was in place and staff were given clear guidelines about the circumstances in which restraint was to be used.

Support plans we looked at included specific risk assessments which identified risks associated with people’s care and guided staff about how to minimise risks in order to keep people safe.

Staff were supported to carry out their role through regular supervision and support and received relevant training required to meet people’s needs.

We saw people had a hospital passport which was comprehensively completed in order to promote their health and wellbeing.

Staff had completed training in relation to Mental Capacity Act 2005, and understood the principles of the Act and how to support people in line with these.

The provider had implemented some systems for continuous oversight of the service, to make improvements in all aspects of the service.

During our inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

The service is registered to accommodate up to ten people with learning disabilities who may also have mental health needs. People living at the service were in receipt of direct payments and were supported by two personal assistants during the daytime and by staff employed by the service during the evening and night. There was one person using the service at the time of our inspection.

The home did not have a registered manager in post, although a prospective manager had been appointed at the time of writing this report. 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.

People were not protected against the risks associated with the unsafe management and use of medicines, as medicine recording and administration records were not accurate. Staff did not receive regular competency checks to ensure they had the correct skills for administering medicines.

Records relating to the recruitment of new staff showed relevant checks were not always completed before staff worked unsupervised at the home.

A safeguarding procedure flow chart was in place and staff were aware of their roles and responsibilities to report safeguarding concerns. However, not all staff had undertaken recent, up to date safeguarding adults training and they were not clearly aware of the signs and symptoms of abuse. They did not have access to an up to safeguarding procedure and relevant contact numbers. We did not see clear guidelines for staff about the circumstances in which restraint was to be used and if staff had considered other, less restrictive techniques prior to this.

Staff did not have clear guidance about how to manage and mitigate risks. Some risks relating to managing people’s health condition and behaviours that challenged were in place. However, risks relating to people’s other specific needs such as their awareness and understanding of danger, for example, when undertaking outdoor activities and road safety, management of medicines, allergies and fire safety were not in place.

CQC requires registered services as a part of their registration to notify the Commission when there are incidents of a safeguarding nature or the police are called out to a home. We found that not all of the required notifications had been made to the CQC.

Staff were not supported to carry out their role through regular supervision and support, nor did they have relevant training to meet people’s needs.

We saw people had a hospital passport. However, this was not comprehensively completed in order to promote people’s health and wellbeing.

Staff had completed training in relation to MCA. However, not all staff understood the principles of the Act and how to support people in line with these.

The provider did not have sufficient systems in place or continuous oversight to make improvements in all aspects of the service and address the deficits we found in the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During our inspection we found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.