Kellan Lodge

Kellan Lodge is a residential care home providing accommodation and personal care for people with learning and physical disabilities. Kellan Lodge accommodates up to four people in one adapted building. At the time of the inspection there was three people living at the service.

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

Throughout the inspection we observed that people were supported by staff who were caring and respectful in their approach. People knew staff well and interacted with them with confidence. However, we found concerns around how the home was managed, documentation relating to care, infection control and prevention and ensuring people were not placed at risk of harm.

Risks to people were not always comprehensively assessed. Guidance and direction to staff on how to minimise risks was not always clear and detailed. This was addressed immediately following the inspection.

The registered manager had not given any consideration to or implemented any additional policies or procedures to support infection control. A number of staff had not received any recent infection control training, which was of concern, considering the current COVID-19 pandemic.

Safe staff recruitment processes were in place to ensure suitable staff recruitment. However, certain checks were not robustly completed to ensure staff were appropriately assessed as safe to work with vulnerable adults.

Staff had not received any specialist training in response to people’s specific health and care needs.

People were not always 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; the policies and systems in the service did not support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

The service was able to in part demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. However, there were some areas where the service was not meeting all elements of best practice. People were not always supported to live full and stimulating lives. Activities provision was not always individualised to people’s likes, hobbies and interests and did not always promote choice, control and independence.

Management oversight of the service was ineffective and did not identify the issues we identified as part of this inspection. Learning and development was not promoted throughout the service so that people’s experience of care could be improved.

We have made recommendations about completing comprehensive risk assessments and the management of infection prevention and control.

Staff understood safeguarding and how to keep people safe from abuse. Staff told us that they received training and supervision to support them in their role.

People received their medicines safely and as prescribed.

People were supported with maintaining a healthy and balanced diet. People were able to choose and prepare what they wanted to eat.

Relatives feedback about the registered manager and care delivery was positive stating that people’s needs were appropriately met. Relatives knew who to speak with if they had any concerns and were assured that these would be dealt with promptly.

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 February 2018).

Why we inspected

During the inspection of another of the provider’s locations registered we identified concerns relating to medicines management and infection prevention and control. As a result, we undertook a focused inspection to review the key questions of safe, effective, responsive and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key question. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have identified three breaches of regulation around person centred care, staffing and good governance. The failings found are detailed in the main body of the report. Please see the safe, effective, responsive 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.

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

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 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 work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Kellan Lodge is a residential care home providing personal care and support for up to four people with learning disabilities. 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. At the time of this inspection there were four people living at the service.

We observed people to be happy and comfortable in the care of the care staff that supported them.

The provider and its care staff team demonstrated a good level of understanding of safeguarding and whistleblowing and were able to explain the steps they would take to protect people from abuse.

Care plans contained detailed and individualised risk assessments which gave clear information and guidance to care staff on how to support people by minimising or mitigating any risks associated with their care and support needs.

We observed there to be sufficient staff to be available to safely meet the needs of people living at the service. Safe recruitment practices were observed to ensure that only staff suitable to work with vulnerable were employed to do so.

The service had appropriate systems and processes in place to ensure the safe management and administration of medicines.

The provider ensured that all care staff received an in-depth induction and training as well as on-going training, development and support to effectively deliver in their role.

People were supported to eat and drink as per their choices, wishes and health requirements. Care staff clearly knew and understood people’s specific requirements when preparing and supporting people with their meals.

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’s needs and choices were assessed prior to their admission to the home. Where the service had assessed people’s needs and confirmed that the service could appropriately meet their needs, care delivery was planned and recorded accordingly.

Care staff supported people to access a variety of healthcare services to enable them to lead an independent and healthier lifestyle.

Throughout the inspection we saw that people were treated with respect, kindness and compassion. People had built positive relationships with care staff that were based on mutual trust and respect.

Care staff ensured that people were always involved in making decisions about their care and support needs. This involved the use of different communication methods especially where people were unable to verbalise their needs.

Care plans were personalised and developed based on people’s needs, requirements and how they wished to be supported in their day to day needs.

The service had not received any complaints since the last inspection. Relatives confirmed they knew who to speak with if they had any concerns or issues to raise.

The provider had processes in place to ensure that the quality of care was regularly monitored and checked so that subsequent learning could take place and improvements made to the delivery of service.

Further information is in the detailed findings below.

We gathered evidence to help us answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led ? We gathered information from representatives of people using the service by speaking with them by telephone. We examined relevant records, spoke to staff, and observed staff supporting people who used the service.

The detailed evidence supporting our summary can be read in our full report.

Is it caring?

People were being appropriately supported with their health needs, and had been provided with opportunities to promote their independence and community involvement. People were treated with dignity and respect.

Is it responsive?

The provider demonstrated that it understood the needs of the community it served and acted on this to plan and design services. The provider worked collaboratively with commissioners, GPs and a range of health professionals to ensure there were co-ordinated pathways of care to meet people's needs. Information on people's experiences was reported, reviewed and acted upon. Feedback was actively sought to ensure people's experiences were improved.

Is it safe ?

Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. The manager had taken people's care needs into account when making decisions about the number of staff and the particular qualifications, skills, and experience staff would need. Recruitment and selection practice was safe and thorough. People's records were communicated to all relevant parties in a timely manner.

Is the service effective?

People's health and care needs were assessed and reviewed at regular intervals and personalised care plans were in place. Representatives of people using the service, including their relatives and other professionals involved with the service completed an annual satisfaction survey to monitor the effectiveness of the service and there were processes in place to ensure actions were implemented.

Is it well led?

Staff felt supported by managers and that communication was good. There were effective systems in place to monitor the service provided, that were well understood throughout. Individuals working within the service were all clear about their responsibilities and could account for their decisions, behaviour and performance. Risks were identified, proactively controlled and mitigated. Governance and reporting was supported by accurate and timely data.

At this inspection we found that, where people did not have the capacity to consent, the provider acted in accordance with legal requirements. We saw that the manager had put systems in place to gain and review consent from the people who lived in the home. We saw documents that had to be completed before the person could commence on covert medication (medication hidden in food or drink). These documents involved all the people who were involved in the person's care, such as community mental health nurse, doctor, relatives and home staff. This aimed to ensure that decisions taken were in the person's best interest. We could see how the covert medicine would be given and when the decision would be reviewed and by whom.

Several people had their medication crushed and given to them with their food as they had difficulty in swallowing. However it was not clear that three people had consented to this. Not all of the people concerned had had their capacity to consent assessed.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans in a pictorial format gave detailed guidance for staff about how they should meet people's needs. The staff we spoke with understood people's support needs.

We saw that medicines were kept safely. We checked records in relation to storage, administration and disposal of medication. We saw a record of staff signatures but this was out of date, staff agreed they needed to update this information promptly.

The manager told us that staff supervision took place. We looked at supervision records for four staff and saw that all received regular supervision.

The people who used this service were unable to communicate their views. We talked with relatives and professionals who visit the home. They confirmed that regular checks were carried out to make sure that people received the quality of care they expected.