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Nayland Lodge Requires improvement

Reports


Inspection carried out on 16 September 2019

During a routine inspection

About the service

Nayland Lodge provides rehabilitation and support for up to eight adults who have a mental health

disorder. There were seven people living at the service on both days of inspection however only one person was receiving a regulated service.

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

Environmental risks in the service had not been identified and mitigated despite known risks to people.

The provider had not raised concerns with the local authority to safeguard people.

Systems were in place to monitor the quality of the service. However, these were not effective and did not highlight concerns raised during the inspection

The environment was not always clean and required improvement. We have made a recommendation about the environment of the service.

End of life planning required further development. We have made a recommendation that the service consults a reputable source to further develop end of life planning.

Staff were recruited safely, were visible in the service and responded to people quickly.

People were given choice and supported to be independent. They were treated with dignity and respect.

Staff knew people well and had developed meaningful relationships with them.

People's health was well managed and there were positive links with other services to ensure that individual health and nutritional needs were met.

People received their medicines when they needed them.

People who received support, and their relatives, made positive comments about the care provided.

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; policies and systems in the service supported this practice.

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 requires improvement (report published 02 August 2018) At this inspection, the required improvements had not been made.

Why we inspected

This was a planned inspection based on the previous rating. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 20 June 2018

During a routine inspection

Nayland Lodge is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Nayland Lodge provides rehabilitation and support for up to eight adults who have a mental health disorder. Nayland Lodge is a large two storey house situated in Colchester and close to all amenities. The premises provide each person using the service with their own individual bedroom and adequate communal facilities for people to make use of within the service.

At the last inspection on 10 November 2015, the service was rated ‘Good’. At this inspection we found the service was now rated overall ‘Requires Improvement’. This is the first time the service has been rated ‘Requires Improvement’.

This inspection was completed on 20 June 2018 and there were eight people living at Nayland Lodge.

A new manager was appointed since our last inspection to the service in November 2015. The manager commenced employment on 3 August 2017, however they were not formally registered with the Care Quality Commission. 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.

Improvements were required to the service’s governance arrangements to assess and monitor the quality of the service. These arrangements had not identified the issues we found during our inspection. The registered provider lacked oversight as to what was happening within the service to make the required improvements and provide suitable support to the manager to ensure compliance with regulatory requirements and the fundamental standards. Improvements were required to ensure lessons were learned and actioned when things go wrong.

Improvements were required to the recruitment practices at the service to ensure these were robust. There was limited evidence to show staff employed at the service had received and attained suitable training. Improvements were required to ensure newly employed staff received a robust induction, formal supervision and an annual appraisal of their overall performance; with aims and objectives set for the next 12 months.

People were protected from abuse and people living at the service indicated they were safe and had no concerns about their safety and wellbeing. Policies and procedures were being followed by staff to safeguard people, apart from safeguarding concerns not being notified to the Care Quality Commission. People received their prescribed medication as they should, however minor improvements were required to ensure the correct codes were recorded on the Medication Administration Records. Risks to people were identified and managed to prevent people from receiving unsafe care and support. Staffing levels and the deployment of staff was suitable to meet people’s needs. People were protected by the registered provider’s arrangements for the prevention and control of infection.

Staff understood and had a good knowledge of the key requirements of the Mental Capacity Act [2005] and Deprivation of Liberty Safeguards. Suitable arrangements were in place to ensure that people’s rights and liberties were not restricted and people’s capacity to make day-to-day decisions had been considered and assessed.

People were treated with kindness, dignity and respect. People received a good level of care and support that met their needs and preferences. Support plans were in place to reflect how people would like to receive their care and support, and covered all aspects of a person's individual circumstances. Staff had a good knowledge and understanding of people’s specific care and support needs and how they wished t

Inspection carried out on 10 November 2015

During a routine inspection

This inspection took place on 10 November 2015 and was unannounced.

Nayland Lodge provides rehabilitation and support for up to eight adults with a mental health disorder. On the day of our inspection there were seven people living in the service.

There was a registered manager in place. 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 were protected from abuse and felt safe living in the service. Staff were knowledgeable about risk of abuse and reporting procedures. There were sufficient staff with the necessary skills to meet people’s individual care and support needs. Safe and effective recruitment procedures were in place.

People received their medicines as prescribed. There were suitable arrangements for the safe storage management and disposal of medicines.

People told us they were happy living in the service and that staff treated them with kindness, dignity and respect. People were given support to maintain a health balanced diet while enjoying meals of their choice.

People told us their needs were met and they were supported to take part in a range of activities both within and outside the service. People and staff were involved in how the service was run. They were encouraged to have their say about how the quality of services could be improved.

There was a system of audits, surveys and reviews which were used to good effect in monitoring the performance and managing risks.

The provider had a clear vision and set of values based on person centred care, independence and empowerment. These were central to the care provided and were clearly understood and put into practice by staff for the benefit of everyone who lived in the service.

Inspection carried out on 14 February 2014

During a routine inspection

People told us that they liked living at Nayland Lodge and that staff were supportive and caring. One person said, "It is really good here, staff are good to us." Another person said, �I love it here.� We found that care was provided according to people's assessed needs and people were included in decisions about how they were to be cared for.

There were effective arrangements to manage medications. Staff were trained and had the skills required to administer medications safely.

We saw that staff were checked appropriately before they commenced working at the service.

Inspection carried out on 28 January 2013

During a routine inspection

Nayland Lodge was registered with us in November 2011 and people were first admitted to the home in February 2012. This was our first inspection of the service. People were admitted to the home for rehabilitation under voluntary agreements and continued to be monitored and treated by consultant psychiatrists at the local trust. Support was also provided by community mental health nurses. People we spoke with told us that they had very good support from the consultant and community nurses.

We spoke with three people living in the home during our inspection. They told us that staff were very supportive and helped and encouraged them to access the local community. They felt fully involved in setting their goals and in identifying the level of support they needed. One person told us, �Staff help you to unravel life�s confusions.� Another said, �It feels very homely here. There�s a good atmosphere.�

The service had systems in place to monitor standards of support and services in the home. Standards of care records were generally good and the manager was addressing any lack of consistency during staff meetings and during supervision with individual members of staff.