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Kellan Lodge Requires improvement

The provider of this service changed - see old profile

Reports


Inspection carried out on 11 December 2020

During an inspection looking at part of the service

About the service

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 manag

Inspection carried out on 4 January 2018

During a routine inspection

This inspection took place on 4 January 2018 and was unannounced. At the last inspection on 24 August 2015 the service was rated Good. At this inspection we found the service remained Good.

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.

Inspection carried out on 24 August 2015

During a routine inspection

This inspection took place on 24 August 2015 and was unannounced. Kellan Lodge provides accommodation and personal care to a maximum of four females with learning disabilities. At the time of our inspection, there were three people using the service.

The provider met all the standards we inspected against at our last inspection on 1 July 2014.

There was a registered manager 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.

Positive caring relationships had developed between people who used the service and staff and people were treated with kindness and compassion. Relatives of people who used the service told us that they were confident that people were safe in the home. Systems and processes were in place to help protect people from the risk of harm. These included careful staff recruitment, staff training and systems for protecting people against risks of abuse.

Identified risks associated with people’s care had been assessed and plans were in place to minimise the potential risks to people.

There were arrangements for the recording, storage, administration and disposal of medicines.

There were enough staff to meet people’s individual care needs and this was confirmed by staff we spoke with. Staff spoke positively about the training they had received. Staff had the knowledge and skills they needed to perform their roles. They spoke positively about their experiences working at the home. Staff told us that they felt supported by management within the home and said that they worked well as a team.

People’s health and social care needs had been appropriately assessed. Care plans were person-centred, detailed and specific to each person and their needs. Care preferences were also reflected.

Staff received training in the Mental Capacity Act 2005 and were able to demonstrate a good understanding of how to obtain consent from people and action to take if people lacked capacity to make decisions for themselves. The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. The home had applied to the local authority for DoLs authorisations for each person.

Relatives spoke positively about the atmosphere in the home and we observed that the home had a homely atmosphere. Bedrooms had been personalised with people’s belongings to assist people to feel at home.

The home had an open and transparent culture. Staff were encouraged to have their say and were supported to improve their practice. We found the home had a clear management structure in place with a team of care staff, the deputy manager and the registered manager.

There was a system in place to monitor and improve the quality of the service which included satisfaction surveys, staff meetings and a programme of audits and checks.

We found the premises were clean and tidy. The home had an Infection control policy and measures were in place for infection control. There was a record of essential inspections and maintenance carried out.

Inspection carried out on 1 July 2014

During a routine inspection

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.

Inspection carried out on 25 July 2013

During an inspection looking at part of the service

We carried out this inspection to check whether the provider had made improvements in the service since we last inspected on the 2 May 2013. At that inspection we found that the provider had not assessed people's capacity related to consent to use covert medication. However, we saw out of date Mental Capacity forms and a letter from the doctor in 2011 stating reason to give crushed medication.

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.

Inspection carried out on 2 May 2013

During a routine inspection

People's diversity, values and human rights were respected. We saw staff knew how to communicate with people. We saw staff knock on doors and announce themselves before entering. Relatives told us "the home is clean and the staff make sure they all get out."

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.

Inspection carried out on 2 July 2012

During an inspection in response to concerns

We observed that people that use the service were supported by staff to undertake activities.

We observed the interactions between the staff and people using the service which were positive and staff conducted themselves in a respectful and supportive manner. This promoted the peoples dignity and rights.

We observed that staff responded to people�s needs. They were approachable and responded to people�s body language and limited verbal communication.

We observed that snacks were offered between meals as requested by the dietician which assisted to promote people�s wellbeing.

We observed that there where enough staff on duty to meet people�s needs.