Archived: St Lukes Lodge

This inspection was brought forward in response to concerns surrounding an alleged incident of serious physical abuse, the actions taken after the alleged incident and the failure to notify the Care Quality Commission (CQC) of the incident at the time. The incident itself remains subject to a criminal investigation and as a result this inspection did not examine the circumstances surrounding it. These events took place during the tenure of the previous registered manager, who was no longer in post at the time of this inspection.

The trustees of St Luke’s Trust had, with support from the local authority and another registered provider, put in place suitable interim management arrangements pending recruitment of a new manager and their application for registration. A new manager had since been appointed and had applied to become registered. 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.

St Lukes Lodge provides supported living support to 10 people with moderate to severe learning difficulties. Service users reside either in the main premises, St Lukes Lodge, or if they need less intensive support, in the on-site annex, known as Lyndale House. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Not everyone using St Lukes Lodge receives regulated activity. CQC only inspects the service being received by people provided with ‘personal care’, help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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.” (Registering the Right Support CQC policy).

We found people were now provided with safe care and support. Appropriate action had been taken to address the previous issues referred to above. The new manager and the staff fully understood their responsibilities to safeguard people from harm and the action they must take if they had concerns about this.

People felt safe and well cared for by the staff and it was evident they felt at ease around all of the staff. Staff had received nationally recognised training on how to support people whose behaviour could sometimes challenge the service.

Identified risks were assessed and action taken to mitigate them as far as possible, without restricting people’s freedom of choice.

A robust recruitment process helped ensure staff recruited had the necessary skills and the right approach to provide the support people needed. Additional staff had been recruited to provide consistent care to people, going forward.

People’s needs were met effectively by staff who understood how people communicated their needs and wishes and who listened to people. People’s diverse needs, their rights, privacy and dignity were protected and respected by staff.

People received appropriate support with their healthcare and dietary needs. Staff consulted external healthcare specialists when necessary and advocated on behalf of people to ensure they received the healthcare they needed.

Staff were appropriately trained and supported to help them deliver effective and consistent care.

People received caring and patient support from staff who actively involved them in decision making and supported them to make meaningful daily choices about their lives.

The high level of commitment of staff to the people they supported, was very evident in their approach and the positive way they spoke about people.

People’s needs and wishes were recorded clearly in detailed care plans which were subject to ongoing review and development. People and their representatives had been consulted about their wishes and needs.

People were enabled to live fulfilling lives and be involved in the local community. They had opportunities to be involved in a wide range of activities. Their views were sought and they felt listened to by the manager and staff.

Effective use was made of a range of assistive technologies to safeguard and improve people’s experience. Key documents had been adapted, using images, to make them more accessible.

The service was moving forward positively under the new management. Effective monitoring and audit tools had been established to help ensure more effective governance by the trustees.

The service was last inspected on 7 January 2014 and was found compliant with the outcomes inspected. St Lukes Lodge provides a supported living service to people with moderate to severe learning difficulties. Seven people were living in the main house (St Lukes Lodge) with a further three people who could manage with less intensive support, living in another building on site (Lyndale House). Twenty-four hour support is provided by a consistent team of staff.

A registered manager was in place as required in the service. 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 using the service preferred to be referred to as tenants and each had an individual tenancy agreement which described their responsibilities and those of the provider. In order to respect their wishes, we have referred to them by this title throughout the report.

Tenants felt the service was well-led. Staff told us they felt involved in the running of the service, valued and listened to by the registered manager. Tenants, staff and external health and care professionals felt the manager was approachable and we saw tenants had a very positive relationship with him. Monitoring systems, internally and externally, were comprehensive and effective and led to timely action whenever an issue was identified. The views of tenants and their families were sought and acted upon. The service sought to continually develop and improve the experience and quality of life of the people it supported and very much involved the tenants and put them first.

Staff received a thorough induction based on the national Care Certificate competencies and their skills and knowledge were rigorously and regularly checked thereafter. They received thorough ongoing training with regular updates and had additional learning and information resources available to encourage self-directed learning. Staff were very well supported through regular supervision, team meetings and annual appraisals. They felt a sense of ownership of their key roles relating to the operation of the service and were highly motivated and enthusiastic. Staff felt their skills were continually monitored and developed; and they were well trained and supported.

Tenants felt the service was very responsive to their needs and provided them with excellent support. Support was provided based on detailed care plans and supporting documents which reflected individual’s wishes and aspirations. The service was very individualised proactive and adopted imaginative and creative ways to meet tenant’s needs and enhance their lives.

Tenants felt safe and well cared for. The service had effective systems and training to safeguard them from harm and staff were fully aware of their responsibilities to protect people and how to report any concerns. Exceptionally, tenants had also attended training on safeguarding to help them to keep themselves safe. Tenant’s rights and freedom were actively protected by staff who had a good understanding of relevant legislation and put this into practice consistently in their day-to-day work. The staff recruitment process was robust. Tenants were actively involved in the process and their views about potential candidates were sought and listened to.

The service was highly skilled at positively empowering individuals and encouraged them to learn new skills and try new experiences. Tenant’s areas of interest and existing abilities were also actively encouraged and facilities and equipment were provided to ensure their lives were fulfilled. We saw numerous examples which demonstrated how the service had a positive impact on tenant’s lives.

Tenants had made very significant improvements to their lives. They had developed their self-esteem, confidence; were learning to manage their own behaviour and choosing healthy lifestyles with the active encouragement of staff. Support and care was provided in a highly person-centred way and tenant’s individuality was positively valued. Interactions showed staff and tenants clearly had extremely positive relationships and tenant’s independence and involvement in decision-making were always actively encouraged. Staff always respected tenant’s dignity and privacy and worked in a friendly, calm and respectful way alongside them.

The environment and grounds were continually developed and enhanced in response to tenant’s needs, wishes and suggestions. Tenant’s views were sought about décor. Their choices were respected and everyone contributed towards the development and maintenance of the environment. Tenants took pride in their contributions and enjoyed a healthier lifestyle as a result.

Health and safety and fire safety matters were comprehensively managed and monitored by designated staff who understood the importance of their role. Tenants had also attended training to increase their awareness of these issues. Where necessary, tenant’s medicines were well managed on their behalf by staff. However, where an individual could manage their own medicines, this was enabled to the fullest extent possible with staff maintaining an overview to ensure they continued to manage them safely.

People's dietary needs were met effectively by staff who had received specialist training where necessary, to do so. They were involved in all aspects of shopping and food preparation to whatever degree was possible. Healthy lifestyles were actively promoted.

The provider had appropriate recruitment and checking systems in place for new staff. Tenants had been involved in the recruitment process. New staff received a detailed induction based on a nationally recognised format.

Staff received appropriate core and specialist training to equip them to meet the needs of the people supported. They were supported through regular supervision, team meetings and annual performance appraisals. Team spirit was good and staff felt their views were taken account of by management.

The manager had systems in place to monitor the performance of the service. The views of tenants on the support they received were regularly sought and acted upon.

All of the service users were unanimous in their praise for the care and support they received from staff. One person told us that the staff were "fantastic". Another said that the service was "great" and that help was always available if needed.

Service users reside at either St Lukes or the annex which is called Lyndale. Those living in Lyndale may require less support than those residing in St Lukes.

Service users had comprehensive care plans that focused on their needs; strengths and hopes for their future. They told us that they felt involved in their care and also in the running of the service.

People were treated as individuals and were encouraged to be part of the local community and access services and facilities in the community. We saw staff and service users interact in a friendly way and heard discussion between them that indicated that staff had been able to build a good relationship with the service users who, in turn, felt able to talk to the staff in a friendly way.

We noted that the building was well maintained and that work was being done to improve the facilities and the environment. We saw the grounds and noted the developments to further enhance the opportunities for the service users to learn new skills or pursue their interests.

We saw that people were supported by staff to make choices that supported the staff's assertions that people were treated as individuals.