Cypress Lodge

Cypress Lodge is a residential care home providing personal care to 7 people at the time of the inspection. The service can support up to 10 people.

Cypress Lodge consists of 2 detached buildings, Cypress Lodge and Willow Cottage. Both buildings provide level access to communal gardens, kitchens, and lounges. Private accommodation is laid out over 2 floors in each building. The manager’s office is located on the ground floor of Cypress Lodge.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Care: Although improvements had been made since our last inspection, further improvement was needed to ensure people received consistently safe care. Areas of people’s private accommodation was still visibly unclean and provider checks had not identified these shortfalls. We found 1 occasion when the provider failed to report unexplained bruising to the local authority safeguarding team and observed 1 person had access to cleaning chemicals on 1 occasion during our inspection.

Right Support: The deputy manager was in the process of introducing a key-worker role to ensure care was more person-centred. People’s thoughts and feelings were explored through ‘it’s all about you’ meetings. Staff told us they respected people’s privacy and protected their dignity.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Culture: Staff told us the culture of the service had improved since our last inspection and there were sufficient numbers of suitably qualified staff to meet people’s needs. The provider was aware of CQC’s framework in relation to inspecting services for people with autism and learning disabilities and was working towards ensuring care delivery in line with these principles.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 16 June 2022)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

This service has been in Special Measures since June 2022. During this inspection, the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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 COVID-19 and other infection outbreaks effectively.

This inspection was carried out to follow up on action we told the provider to take at the last inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cypress Lodge provides support for up to 10 people with learning disabilities, autism, and mental health needs. At the time of our inspection there were eight people using the service.

Cypress Lodge is laid out over two detached buildings, Cypress Lodge and Willow Cottage. Both buildings provide level access to communal gardens, kitchens and lounges. Private accommodation is laid out over two floors in each building. People have access to the hub, a large building with tables, chairs and a chalk board. The manager’s office is located on the ground floor of Cypress Lodge.

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

At this inspection, we found improvements had been made in response to the warning notice we issued previously. The provider had worked with the fire service and commissioned a contractor to undertake required fire safety work. The manager had improved how controlled drugs and COSHH items were managed, and the maintenance team had repaired areas of the service that were damaged.

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 inadequate (published 16 June 2022).

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Cypress Lodge is a learning disability service providing personal care to up to 10 people. The service provides support to people with learning disabilities, autism, and mental health needs. At the time of our inspection there were eight people using the service.

Cypress Lodge is laid out over two detached buildings, Cypress Lodge and Willow Cottage. Both buildings provide level access to communal gardens, kitchens and lounges. Private accommodation is laid out over two floors in each building. People have access to the hub, a large building with tables, chairs and a chalk board. The manager’s office is located on the ground floor of Cypress Lodge.

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

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Right care:

The service was not always caring; staff were observed smoking in the designated smoking area in peoples’ garden. We heard one staff member speak with a person in an undignified way and the environment did not promote people to live dignified lives. People had been supported to attend funerals for loved ones.

Right support:

The provider failed to act and reduce the risk of avoidable harm to people; we identified concerns in relation to fire safety, environmental maintenance and risks of burns from hot surfaces. Medicines were not always managed safely and there were insufficient numbers of suitably qualified staff deployed across the service.

Right culture:

The provider failed to establish checks and audits and use them effectively to identify shortfalls, errors and omissions. There was no registered manager at the time of our inspection. The manager was working to improve the service and introduce new ways of working.

Based on our review of safe, well-led and caring, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The environment required maintenance work, medicines were not always managed safely, and we heard a staff member speaking to one person in an undignified way.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. There were systems in place to identify and report potential safeguarding concerns and staff we spoke with were confident about how they would identify potential abuse.

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 29 August 2018).

Why we inspected

The inspection was prompted in part due to concerns we received about potential abuse and unsafe staffing levels. A decision was made for us to inspect and examine those risks.

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 COVID-19 and other infection outbreaks effectively.

We issued a letter of intent and the provider responded with an action plan to address our most serious concerns.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the safe, caring and well-led sections of this full report.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection. 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 Cypress Lodge on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safe staffing and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

After our last Inspection in May 2017 we asked the provider to complete an improvement action plan. This was because we had identified shortfalls in two of our key questions. Is the service Safe? And Is the service Well Led?

At our last inspection in 2017 we had found that medicine administration systems that were in place were not fully safe. Improvements were needed to ensure people always received their medicines when they needed them and that medicines were stored correctly. Staff administered medicines to people; no one self-medicated.

We had also found at that inspection in that quality assurance systems were not fully effective in ensuring people received consistently high-quality care, that the service complied with the law or that necessary improvements were carried out.

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.

There was no registered manager at the time of our visit. The acting manager was in the process of applying to be registered with CQC. 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.

The home had a relaxed atmosphere and people were being supported by staff who knew them well. Although the impact of inspection could have been great on the senior staff they continued to be focused on people using the service and ensured that their plans and needs were addressed.

The staff leadership were intent on continuing to make progress that had commenced after the last inspection. Comments made indicated that there was a drive to develop the service and build on the skills and abilities of staff to successfully support people to develop their independence.

The premises were plain but functional and it was clear that both homes were lived in and well used by the people who occupied them. They were not clinically tidy but instead showed evidence of being peoples own space with some personal belongs in lounge areas such as games, magazines and drinks on side tables when people were watching television or chatting.

The staff had been on training about abuse and had the knowledge and insight to know how to keep people safe. This helped people to be supported to stay safe in their home and out in the community.

People felt well supported to have choice and control of their lives. The staff team supported people in positive ways. There were policies and systems to support the staff to do this effectively.

The principles of the Mental Capacity Act were implemented in the home. There were policies and systems in the home that supported the staff and people who lived there.

People were supported to have enough to eat and drink to maintain good health and wellbeing. People were encouraged to cook meals and snacks for themselves.

People were supported flexibly in ways that ensured their individual needs and preferences were met. Care plans were personalised and guided staff to provide care and support in the way people preferred.

Activities were planned with people in an individualised way. This was to reflect the interests wishes and choices of each person.

Cypress Lodge provides support for up to 10 people with learning disabilities. There are two houses that can accommodate five people in each, Cypress lodge and Willow Cottage. At the time of the inspection there were five people living at Cypress Lodge and five people living at Willow Cottage.

At the time of the inspection there was no registered manager registered to manage 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. The registered manager left the service in December 2015 and a registered manager from one of the provider’s other homes was overseeing the home. The provider had appointed a service manager oversee the day to day running of the home and they reported directly to the acting registered manager.

People told us staff treated them well, however they did not always feel safe with the people they lived with. The acting manager and service manager were addressing these concerns.

Some improvements were required to ensure people always received their medicines when they needed them and that medicines were stored correctly. Risks to people were not always fully assessed or planned for.

There were quality assurance processes in place to monitor care and safety and plan on-going improvements. These processes were not fully effective in identifying the shortfalls we found during our inspection or ensuring improvements were always carried out.

The provider was not notifying us of all incidents and in line with their legal responsibility. Staff felt supported by the home’s managers, although they did not always feel listened to by senior managers.

People were supported by a sufficient number of staff to keep them safe. Staff had enough training to keep people safe and meet their needs.

People were supported by staff who know how to recognise and report abuse. People received effective support to help them manage their behaviour. Staff recruitment was managed safely.

Staff knew people well and understood their care and support needs. People made choices about their own lives and their legal rights in relation to decision making and restrictions were upheld.

People’s diverse needs were well supported; they chose a range of activities and trips out. People were part of their community and were encouraged to be as independent as they could be. People received support from a range of health and social care professionals.

People were aware of the complaints procedure and felt able to raise any concerns. There were systems in place to share information and seek people's views about their care and the running of the home.

There was a management structure in the home, which provided clear lines of responsibility and accountability. All staff worked hard to provide the best level of care possible to people. The aims of the service were defined and adopted by the staff team.

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