Archived: High Street Lodge Limited

Updated 19 September 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on 5 and 7 December 2018 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we needed to be sure that the registered manager would be available to support us with the inspection process.

This inspection was carried out by one inspector and one expert by experience. During the inspection we visited the office and two of the supported living schemes. The expert by experience made telephone calls and spoke with the relatives of people using the service. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

We also reviewed information we had about the provider, including notifications of any safeguarding or other incidents affecting the safety and well-being of people using the service.

We spoke with three people who used the service and five of their relatives. We also observed interactions between staff and people using the service as we wanted to see if the way that staff communicated and supported people had a positive effect on their well-being.

We spoke with the registered manager, senior support worker and three support staff. We also looked at four staff files and training records.

We looked at five people’s care plans and other documents relating to their care including risk assessments and medicines records. We looked at other records held at the home including staff meeting minutes as well as health and safety documents, complaints and quality audits.

Updated 19 September 2019

This inspection took place on 5 and 7 December 2018 and was announced.

High Street Lodge Ltd provides care and support to people living in three ‘supported living’ settings, so that they can live in their own home as independently as possible. 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 High Street Lodge Ltd receives a 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 service supports people with a mental health condition. The service can accommodate a maximum of 17 people. On the day of the inspection there were nine people using the service.

A registered manager was in post at the time of this 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.

High Street Lodge has been inspected three times since February 2016. In February 2016 we found significant shortfalls in the care people received and the way in which the service was managed. We identified breaches of seven Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to inadequate risk assessments, people not being involved in planning their care, inadequate provision of staff training, staff not understanding of the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS), a lack of staff supervision and a lack of auditing processes to ensure good governance and overall management of the service. Enforcement action was taken against the provider and the registered manager.

In September 2016 we inspected the service to check whether the required improvements had been made. We found that although some improvements had been made the service continued to be in breach of the regulations. We found that some aspects of risk management were not safe and there was a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Due to the serious nature of the breach we took further enforcement action against the registered provider.

In April 2017 we carried out a focused inspection to check that the most significant breach of legal requirements in relation to Regulation 12, concerning risk assessments, which had resulted in enforcement action, had been addressed. During this inspection we found that the provider had addressed this issue and were no longer in breach of the regulations. The service was rated overall ‘Good’.

At this inspection we found significant concerns and shortfalls in the care and support people received and the overall management of the service. Improvements that had been made previously had not been sustained.

Although the service identified and assessed people’s risks associated with their health and care needs, not all risks were appropriately assessed. This meant that care staff were not given appropriate information and guidance on how to manage people’s risks and keep them safe and free from harm.

Medicines management and administration was not safe. People were not always receiving their medicines safely and as prescribed.

Senior care staff completed monthly medicines audits, however, these did not identify any of the issues that we highlighted as part of this inspection. The registered manager did not monitor and evaluate the overall quality of care and support people received so that issues could be identified, improvements made and further learning and development implemented.

The registered manager and senior care worker had not improved on their level of knowledge on how to meet the regulations, especially considering that the service had a history of non-compliance.

People did not receive care and support that was in line with current best practice and reflective of their needs and requirements. Where change in people’s health and care needs had occurred, care plans had not been reviewed or updated to reflect this.

Records written about people, especially in relation to incidents, were not person centred. People were not referred to with dignity and respect.

Although we observed sufficient numbers of staff available to meet people’s needs we could not always be assured that where people required support to go out and take part in activities, sufficient number of staff would be available to support them.

People were not supported to engage and participate in a variety of activities that they may have enjoyed. People were observed sitting at home either in the lounge or in their own bedrooms with very little in the form of stimulation available to them to support them with positive well-being.

The service had not involved people or their relatives to give feedback about the quality of care and support that they and their relative received. This meant that the service was unable to learn and improve where required.

Care staff told us and records confirmed that they were supported through regular training, supervision and annual appraisals. However, where care staff received medicines training, competency assessments were not completed to assess that staff were competent when administering medicines.

People and their relatives told us that they felt safe when receiving support from the care staff at High Street Lodge Ltd. Care staff demonstrated a good understanding of how to recognise abuse and the steps they would take to report this.

Safe recruitment processes in place ensured only those staff assessed as suitable to work with vulnerable adults were employed.

People told us that they had enough to eat and drink. Some people were able to purchase and cook their own food and staff supported them. In some houses, staff cooked for people. Care staff told us that people were given choice when deciding what to eat.

People were supported to have some 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. People, where possible, had consented to the care and support that they received.

The service had no recorded complaints since the last inspection. Policies in place gave clear direction on how people and their relatives could complain. People and their relatives knew who to speak with if they wanted to raise a concern.

We identified breaches of Regulations 9, 10, 12 and 17 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.

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.

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.